AccountId: 011433970860
ContactId: 0d69e3f9-e8e8-421e-9c23-893a57903b07
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 269160 ms
Total Talk Time (AGENT): 115999 ms
Total Talk Time (CUSTOMER): 93343 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/0d69e3f9-e8e8-421e-9c23-893a57903b07_20250305T17:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good afternoon. This is [PII] and I'm with provider's office. How are you doing today?
[AGENT][POSITIVE] I'm doing well, [PII] how are you?
[CUSTOMER][POSITIVE] I'm pretty good, thank you so much for asking. I'm [PII], I'm looking for the claim status.
[AGENT][NEUTRAL] Sure, I can check on a claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII] I'm [PII]. It's a direct line.
[AGENT][NEUTRAL] OK, thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] I do. It's 01900031 M like Mary, L like Lima 8.
[AGENT][NEUTRAL] OK, and then, uh, what was the name and date of birth for the insured please?
[CUSTOMER][NEUTRAL] Uh, [PII], I say [PII] Fine, uh, like, date of birth [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII] and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK and uh what was that bill amount please?
[CUSTOMER][NEUTRAL] $200.07.
[AGENT][POSITIVE] OK, got it thank you one moment please.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] I'm sorry, [PII], what was the name of the provider this was with?
[CUSTOMER][NEUTRAL] Health Holdings Company LLC.
[AGENT][NEUTRAL] OK, do you believe I've found it one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, yes, so we did receive this claim, uh, we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK, you're going to say claim was denied?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Help you with the receipt date.
[AGENT][NEUTRAL] Yes, one moment, let me get that. This claim was received [PII], and it was processed [PII].
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] and claim was denied and.
[AGENT][NEUTRAL] That's the same date that it was processed, uh, [PII].
[CUSTOMER][NEUTRAL] OK. Uh, denied as non-covered?
[AGENT][NEUTRAL] Right offices if they're not covered under this policy.
[CUSTOMER][NEUTRAL] OK, office visits are non-covered under the policy.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Members's plan, what is the members plan type?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] This is a secondary medical plan, it is supplemental.
[CUSTOMER][NEUTRAL] Medical plan supplemental, right?
[AGENT][NEUTRAL] Correct, secondary medical.
[CUSTOMER][NEUTRAL] OK. So does secondary medical uh cover patients co-pay?
[AGENT][NEUTRAL] It is designed to help with co-pay, deductible and co-insurance after major medical pays. However, it does have its own policy and office visits are not a covered benefit for this policy.
[CUSTOMER][NEUTRAL] OK, help me with the claim number?
[AGENT][NEUTRAL] That is 33.
[AGENT][NEUTRAL] 256-69
[CUSTOMER][NEUTRAL] OK, can you please fax me you have my fax number?
[AGENT][NEUTRAL] Of course, what was that fax number for you?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and would I just put this to your attention, [PII]?
[CUSTOMER][NEUTRAL] You can put my name and what is the turnaround time?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, you should get it here within 10-15 minutes.
[CUSTOMER][NEUTRAL] OK, uh great. Do you mind helping with the call reference number for this call?
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] Yes, uh, I just want to confirm the claim number is 332-56669.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Great, thank you. That's fine today. Have a good day. Stay safe.
[AGENT][POSITIVE] You're welcome. Thanks. You too. Bye bye.
[CUSTOMER][NEUTRAL] Bye.