AccountId: 011433970860
ContactId: 222988ac-9bc2-4877-a3ca-affb6da3f94e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 222940 ms
Total Talk Time (AGENT): 99103 ms
Total Talk Time (CUSTOMER): 43437 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/222988ac-9bc2-4877-a3ca-affb6da3f94e_20250609T17:12_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi there, my name is [PII] from provider's office looking for a claim status.
[AGENT][NEUTRAL] OK, you're needing claim status for one member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And can you spell your first name for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and your callback number, please?
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] Sure, that is going to be 013.
[CUSTOMER][NEUTRAL] 43216 M. like Mary L. like Lima number 8.
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] And any information costs that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] Problem.
[AGENT][NEUTRAL] And the date of service and total bill amount for him please?
[CUSTOMER][NEUTRAL] Your [PII] total charge amount on this claim is $390 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, so I do show that this claim was received on [PII].
[AGENT][NEGATIVE] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 360.
[AGENT][NEUTRAL] 422 5.
[AGENT][NEGATIVE] And this, and code 92014 was denied.
[AGENT][NEUTRAL] On this policy and the reason for the denial is that office visits are not covered by the above number policy.
[AGENT][NEUTRAL] The members supplemental plan, Akash does not cover office visits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now if you need a copy of that explanation of benefits now that you have the claim number, you should be able to print that yourself by going to our portal which is located at secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Alright, uh, can I get a call reference number?
[AGENT][NEUTRAL] Sure, you would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] Thank you so much for your help and time.
[AGENT][POSITIVE] Well, you're very welcome. So if that is all I can help you with, thank you again for calling APL and I hope you have a nice rest of your day.
[CUSTOMER][POSITIVE] You too take care.
[AGENT][POSITIVE] Uh-huh, thank you. You too. Bye bye.
[CUSTOMER][NEUTRAL] OK.