AccountId: 011433970860
ContactId: 10c982f8-6ddf-4331-b1fc-4b75cdc69fba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 303040 ms
Total Talk Time (AGENT): 90056 ms
Total Talk Time (CUSTOMER): 54614 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/10c982f8-6ddf-4331-b1fc-4b75cdc69fba_20250519T18:18_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], my name is [PII]. I'm calling because I have um uh some claims that denied I need to get some help with, please.
[AGENT][POSITIVE] Alright [PII], happy to take a look at claims. Do we have policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am. Policy number is 02110745.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me pull this up here.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And then if I can get patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], uh, [PII].
[AGENT][NEUTRAL] Thank you for that and then what's the data service?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then the bill amount.
[CUSTOMER][NEUTRAL] $479.10.
[AGENT][NEUTRAL] OK, let me take a look here.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] So we did get a claim [PII], it looks like for this state of service.
[AGENT][NEUTRAL] Um, it looks like it was denied stating office visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then the other denials are showing that the insured's primary paid full benefits, so there was nothing additional for us to pay.
[CUSTOMER][NEUTRAL] OK, so this insurance doesn't cover the office visit?
[AGENT][NEUTRAL] It doesn't cover the office visit fee correct.
[CUSTOMER][NEUTRAL] OK, what does this insurance cover?
[AGENT][NEUTRAL] So as far as an office visit, it would cover any sort of treatment in the office, just not the co-pay for the office visit fee.
[CUSTOMER][NEUTRAL] OK, so it, it covers labs, it covers injections, EKGs, all of that?
[AGENT][NEUTRAL] Um, I can see if EKGs are covered under here. I'm not 100% certain. One second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just say diagnostic testing. Let me see if it breaks it down as far as what all that is.
[AGENT][NEUTRAL] So it looks like the only testing that I can see under diagnostic is just for like MRI and an MRI facility or outpatient facility.
[CUSTOMER][NEUTRAL] OK, but like COVID, flu tests, all that in the office?
[AGENT][NEUTRAL] Yeah, that would be considered under their outpatient benefits because we're the secondary.
[CUSTOMER][NEUTRAL] OK, so that would cover, right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That's what I needed. Thank you very much.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] OK.