AccountId: 011433970860
ContactId: 0f5c14f6-c050-4301-bcb0-a03658304394
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 385089 ms
Total Talk Time (AGENT): 138520 ms
Total Talk Time (CUSTOMER): 124517 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/0f5c14f6-c050-4301-bcb0-a03658304394_20250527T13:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], which is spelled as [PII] and the initial of my last name is [PII]. I have called on behalf of provider's office to check on claims. Could you please spell me your name for the documentation purpose?
[AGENT][NEUTRAL] Um, yes, my name is [PII]. It's spelled [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. And could I, you're welcome. Could I please get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, ma'am. It is [PII]. It's a direct line.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And please repeat your name.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. And yes, I can assist you with claim status. Let me get the policy number, please.
[CUSTOMER][NEUTRAL] Sure, ma'am. The policy number is
[CUSTOMER][NEUTRAL] 02538256
[AGENT][NEUTRAL] OK. And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] The patient's name is [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK, thank you. I found him in our system. um, what's the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] It's [PII] for $268.95.
[AGENT][NEUTRAL] You said $216.95?
[CUSTOMER][NEUTRAL] Um, it is, just give me a minute.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, $216.95. 216.95.
[AGENT][NEUTRAL] OK. Yes, ma'am. We received that claim on [PII].
[AGENT][NEUTRAL] It processed on [PII].
[AGENT][NEUTRAL] The claim number is 3599153.
[AGENT][NEUTRAL] And the claim denied because under this policy, office visits is not covered.
[CUSTOMER][NEUTRAL] Is it under the patient's responsibility?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] All right. So,
[CUSTOMER][NEUTRAL] We can build the patient on this, correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] All right, thank you. I do have one more member. Could you please help me with that?
[AGENT][NEUTRAL] Yes, ma'am. One moment, please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] OK. Thanks for your patience. I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] Yes, ma'am. Is it going to be the same call reference number or different call reference number for both the patients?
[AGENT][NEUTRAL] It'll be the same call reference number, which is my name and today's date.
[CUSTOMER][NEUTRAL] All right. Uh, it is E D D Y and M as in Mary, correct?
[AGENT][POSITIVE] Yes, ma'am, that's correct.
[CUSTOMER][NEUTRAL] All right. And yes, the policy number is 02569253.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you. Now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII], [PII] for $562.33.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Yes, ma'am. We received that claim on [PII].
[AGENT][NEUTRAL] It processed on [PII].
[AGENT][NEUTRAL] The claim number is 359-9031.
[AGENT][NEUTRAL] And it paid out for $26 even.
[AGENT][NEUTRAL] Um, it was a single check.
[AGENT][NEUTRAL] And the check number is 2,043,480.
[AGENT][NEGATIVE] And line one on the claim denied, which is for an office visits, and office visits are not covered under this policy, which is why line one denied.
[CUSTOMER][NEUTRAL] All right. May I know what plan does not um cover office visits for the future reference?
[AGENT][NEUTRAL] Well, it depends. It, we would have to look it up by the claim number because some of these um claims, some of these policies do cover office visits.
[AGENT][NEUTRAL] So we would have to go by the claim number or the policy number. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] All right, thank you. Yes, ma'am. That's all I have for today. Thank you so much for helping me and I wish you have a great day. And to verify once again, your name was [PII]. Is that correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] All right then, thank you so much for helping me and I wish you have a great day.
[AGENT][POSITIVE] OK, and I thank you, [PII], since there isn't anything else I can assist you with, I thank you for calling ATL. You have a great day as well. Mm, bye.
[CUSTOMER][NEUTRAL] Bye.