AccountId: 011433970860
ContactId: 1f015eef-6960-4332-91fa-39a26c68e78b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 390489 ms
Total Talk Time (AGENT): 106870 ms
Total Talk Time (CUSTOMER): 155057 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/1f015eef-6960-4332-91fa-39a26c68e78b_20250416T16:19_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, hi, my name is [PII] calling from Opta Medical KPC. Can you please help me with the claim status of the member?
[AGENT][NEUTRAL] Uh yes, I can help you with claim status. Uh, can you please spell your name for me and the name of the facility again, please?
[CUSTOMER][NEUTRAL] I can
[CUSTOMER][NEUTRAL] Yeah, my name is [PII] and last initial, my name is [PII] and uh
[CUSTOMER][NEUTRAL] Facility's name is Optta Medical KPC.
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Patient's name is last name is [PII].
[CUSTOMER][NEUTRAL] And first name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is [PII]'s policy number, please?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, the policy number is 01939623M as in Mary L as in Lima 8.
[AGENT][NEUTRAL] Thank you. And then Ms. [PII], what is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII].
[CUSTOMER][NEUTRAL] One moment please.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, sure, [PII].
[AGENT][NEUTRAL] Thank you. And then can I get [PII]'s date of service and charge amount?
[CUSTOMER][NEUTRAL] Just a
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] The service is [PII] and total buildup is $1,716.
[AGENT][NEUTRAL] OK. Alright, let me look up his policy.
[AGENT][NEUTRAL] Alright, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Keep the charge amount after the.
[CUSTOMER][NEUTRAL] Uh, it was $540.93.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold, Miss [PII], while I look up this client for us and I'll be right back.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you, [PII], for holding for me. I have the claim ready for you. The claim number is 358-039-8.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 35
[AGENT][NEUTRAL] The claim was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Be honest.
[CUSTOMER][NEUTRAL] The explanation in the primary.
[CUSTOMER][NEUTRAL] As previously we we already sent that explanation of benefits.
[AGENT][NEUTRAL] OK, this claim was reported on [PII] and it was processed on [PII] and we have not received any additional information since then.
[CUSTOMER][NEUTRAL] This.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Digital
[CUSTOMER][NEUTRAL] OK, then you need to, you just need uh explanation of benefits from primary pay, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And you also need to collect a claim from the insurance.
[AGENT][NEUTRAL] No, we just need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] If I send that, the claim will process, right?
[AGENT][POSITIVE] Yes they can complete it.
[CUSTOMER][NEUTRAL] Yes, thank you. Thank you so much for giving me this information. And uh the address which I have to send us the mailing address is, I'll tell you, it was a [PII] City. OK, [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, thank you so much for giving me that information. And could you please also help me with your name and the car reference number?
[AGENT][NEUTRAL] Yes, ma'am. My name is [PII]
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And you can use my name and today's date for the call reference.
[CUSTOMER][NEGATIVE] It it's not.
[CUSTOMER][NEUTRAL] And can you also please help me with your last initial your name?
[AGENT][NEUTRAL] It's A
[CUSTOMER][POSITIVE] Thank you, sorry, for giving me this information. Have a great day and bye for now.
[AGENT][POSITIVE] You have a wonderful day too, Ms. [PII]. That's everything I can help you with today?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] No, thank you so much.
[AGENT][POSITIVE] You're welcome. You have a great weekend and thanks for calling APL ma'am. Bye-bye.
[CUSTOMER][NEUTRAL] Bye for now.
[CUSTOMER][POSITIVE] Oh thank you so much. You too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.