AccountId: 011433970860
ContactId: 1e1e45ad-a831-4ffe-8fc5-f31c78eb7098
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 237899 ms
Total Talk Time (AGENT): 106779 ms
Total Talk Time (CUSTOMER): 96835 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/1e1e45ad-a831-4ffe-8fc5-f31c78eb7098_20250331T13:27_UTC.wav
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[AGENT][NEUTRAL] Compacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. My name is [PII]. I'm calling from the provider's office and I'm looking for information about a claim.
[AGENT][NEUTRAL] I can help with claim status, [PII]. What is that policy number, please?
[CUSTOMER][NEUTRAL] Um, where did it go? I just had it two seconds ago. I must have pulled it out. One second. I'm sorry, go back to the chart.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Um, group number individual number, OK, so it's 023.
[CUSTOMER][NEUTRAL] 19319.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you. And the date of service, please?
[CUSTOMER][NEUTRAL] [PII] of this year.
[AGENT][NEUTRAL] [PII]. OK, thank you. Is there a callback number I can have in the event we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][POSITIVE] OK, thank you very much. Excuse me just a moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, is there, let's see, is there a particular build amount for that [PII] because it looks like we've got several things here.
[CUSTOMER][NEUTRAL] $459.
[AGENT][POSITIVE] I appreciate that. Thank you. The claim number is 3559327. So first of all, um,
[AGENT][NEUTRAL] [PII], she has a new policy. Whenever they renew as a group, they always get a new policy uh for the secondary insurance and that policy number is 02.
[AGENT][NEUTRAL] 47
[AGENT][NEUTRAL] 5985. Now,
[AGENT][NEGATIVE] The policy covers many things, but office visits, co-pays are not one of them. So we received your claim on the [PII]. We processed that on the [PII], but that was a denial because the policy does not cover any sort of office visit.
[CUSTOMER][NEGATIVE] Oh, OK, because this, the denial that I have and maybe I'm looking at the wrong one, the denial that I had, it says the patient can't be ID'd as our insured. So maybe because the ID numbers switched and then they realized what it was, they processed and they denied it saying that the whole page from the previous insurance is not covered.
[AGENT][NEUTRAL] Right, yes. And so it looks like we received this multiple times. Um, it looks, uh, and so I think the first time we received it, we weren't able to identify the, the insured, uh, but then we were, and, uh, when we did identify her, it's, uh, we got the policy and that's the policy number I gave you, but unfortunately, um, it doesn't cover uh any sort of um uh office visit co-pays.
[CUSTOMER][NEUTRAL] OK, and just let me just make sure I have the right one. This is my life, so the new ID number is 02475985, right?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][POSITIVE] OK, so they did update it so no one is in here. OK, fine, that's perfect. All right, they did update it. OK, perfect. And this is a supplemental plan, correct?
[AGENT][NEUTRAL] Is there anything
[AGENT][NEUTRAL] It is, yes. Uh, this is a secondary or gap insurance through her employer.
[CUSTOMER][NEUTRAL] OK, so I have.
[CUSTOMER][NEUTRAL] OK, so because they have it listed as a property and that's no, that was it. They have listed it correctly and I'm gonna go ahead and update that on her file so we can send it to the correct.
[AGENT][NEUTRAL] Is there anything else I can help with?
[AGENT][NEUTRAL] 00, no, no, no, this is gonna be 2nd.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Plan going forward. I just need the reference number for our call today.
[AGENT][NEUTRAL] Yes, my name is [PII], and the first letter of my last name is [PII]. We're gonna use that today's date as a reference.
[CUSTOMER][POSITIVE] Thank you so much. You have a good one. Enjoy the rest of your day, [PII].
[AGENT][POSITIVE] OK, thanks for contacting ATL.