AccountId: 011433970860
ContactId: 10f44a07-5a70-49ec-a09e-fed5cfe8aae8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 168240 ms
Total Talk Time (AGENT): 89291 ms
Total Talk Time (CUSTOMER): 60249 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/10f44a07-5a70-49ec-a09e-fed5cfe8aae8_20250604T18:11_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], I'm [PII] from Community Medical Associates for claim status.
[AGENT][NEUTRAL] OK, [PII], I have the same status. What is that policy number, please?
[CUSTOMER][NEUTRAL] It's gonna be 024497773.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient's name [PII]. Date of birth [PII].
[AGENT][POSITIVE] I appreciate that. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII], and it's a direct line?
[AGENT][POSITIVE] I appreciate that. Thank you. And what is that date of service that we're looking for for [PII]?
[CUSTOMER][NEUTRAL] [PII] for $267 even.
[AGENT][NEUTRAL] OK, thank you very much. Um, the claim number on this.
[AGENT][NEUTRAL] It's 35.
[AGENT][NEUTRAL] 98986.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it looks like uh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like we received your claim on the [PII]. We processed it on the [PII].
[AGENT][NEUTRAL] These policies do not cover the office visits, um, no matter what the the place of service, the office visit does not cover.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so this is a denial for claim 359-898-6 because the office visits are not covered.
[CUSTOMER][NEUTRAL] Alright, thank you so members responsible for the charges, correct?
[AGENT][NEUTRAL] Well, I can't really tell you that. The only thing I can tell you is that we won't cover it. Um, it, it's possible they may have another policy that they can submit it to, uh, but this policy does not cover it.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] All right. Under this policy, the member, sorry, these offices are not covered.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Thank you. By any chance, you'll be able to send a copy of, yeah, copy of EOB that reflects patient responsibility?
[AGENT][NEUTRAL] Yeah, this is the only
[AGENT][POSITIVE] Yes, of course.
[AGENT][NEUTRAL] What is that uh fax number that I may send this to?
[CUSTOMER][NEUTRAL] Sure. It's gonna be [PII] and attention it to my name, [PII].
[AGENT][NEUTRAL] Oh, OK, thank you. 9254. OK, thank you. OK, [PII], is there anything else that I can look up for you? Any other claims, any other dates of service?
[CUSTOMER][NEUTRAL] Um, no, I'm down for the day, just a call reference number please.
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII], and we're gonna use that in today's date as our records. So I will go ahead and pull that and and send that on to you.
[CUSTOMER][POSITIVE] Thank you have a great day bye bye.
[AGENT][POSITIVE] OK, thanks for contacting you too have a good day.