AccountId: 011433970860
ContactId: 27292962-8098-4c71-a14b-3926bd870f4b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1148410 ms
Total Talk Time (AGENT): 151244 ms
Total Talk Time (CUSTOMER): 124321 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/27292962-8098-4c71-a14b-3926bd870f4b_20250121T21:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATFL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from Bo's office to check on claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Uh, can you please give me your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] That is
[CUSTOMER][NEUTRAL] Yeah, it's [PII] [PII].
[AGENT][NEUTRAL] OK, thank you, [PII] and then what is um the.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Insured's name?
[CUSTOMER][NEUTRAL] Yeah, number's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, and then what is [PII]'s policy number?
[CUSTOMER][NEUTRAL] That's 01842027. M as in Mike, L as in Lima.
[CUSTOMER][NEUTRAL] Number 8.
[AGENT][NEUTRAL] Thank you. And then what is the date of service?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII]. The amount is $250 even.
[AGENT][NEUTRAL] OK, and what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mm, and then the balance amount is $60.
[AGENT][NEUTRAL] 60. OK. And what is the name of the facility that you're calling for?
[CUSTOMER][NEUTRAL] What's the name of
[CUSTOMER][NEUTRAL] Yeah, it's MatMed LLC.
[AGENT][NEUTRAL] Can you spell that first name for me, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK. All right, [PII], I'm gonna put you on hold while I look that claim up for you and I'll be right back.
[CUSTOMER][NEUTRAL] I was just like
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi, [PII], this is [PII] back with you.
[AGENT][NEUTRAL] So I found the claim and the claim was processed on
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me let you know it was received on [PII] and processed on [PII].
[AGENT][NEUTRAL] The claim was denied because the services were rendered after the policy terminated.
[AGENT][NEGATIVE] So the insured did not have coverage, and I do not find another policy on file that is active.
[CUSTOMER][NEUTRAL] OK. So can you do one thing? What's the effective date and the termination date for this?
[AGENT][NEUTRAL] Yes, I can tell you that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The effective date is [PII].
[AGENT][NEUTRAL] And the policy termed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK, and.
[CUSTOMER][NEUTRAL] So it, uh, it goes for [PII] as well, right? Because I have one more claim for [PII].
[AGENT][NEUTRAL] Uh, what is that, do you have that claim number?
[CUSTOMER][NEUTRAL] I don't, uh, can you just give me the claim number for this one for [PII] [PII]?
[AGENT][NEUTRAL] Yes.
[AGENT][NEGATIVE] Yes, it's 3552 wait a minute, that's the wrong one.
[AGENT][NEUTRAL] 3549062
[CUSTOMER][NEUTRAL] 3749062 is the correct one?
[AGENT][NEUTRAL] 3549062
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] 6263.
[AGENT][NEUTRAL] 62.
[CUSTOMER][NEUTRAL] Yup. Uh, and what about, uh, [PII]? Will the amount is, uh,
[CUSTOMER][NEUTRAL] $460 even.
[AGENT][NEUTRAL] OK, what's the name of the facility?
[CUSTOMER][NEUTRAL] Yeah, it's the same. I'm talking about the same patient.
[AGENT][NEUTRAL] OK, and is the same facility?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I don't find a claim on file for that facility.
[CUSTOMER][NEUTRAL] OK. For MatMed LLC, you don't see a claim for [PII].
[AGENT][NEUTRAL] Let me check again.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] I'm, I'm looking, sir.
[AGENT][NEUTRAL] OK, I do find the claim the claim number.
[CUSTOMER][NEUTRAL] Uh, actually your voice is, uh,
[AGENT][NEUTRAL] The claim number is 353.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 7492.
[AGENT][NEUTRAL] And let me look to see.
[AGENT][NEUTRAL] And the claim was denied for the same reason.
[CUSTOMER][NEUTRAL] OK. And uh what's the denial date or the process date?
[AGENT][NEUTRAL] Let me give that to you real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We received the claim on [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] OK. So you don't see any other policy? Or is there any other policy with a different member ID?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, there's no poli uh no policies that are active on file.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK. Can you spell your name?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. What's the reference number, Tory?
[AGENT][NEUTRAL] You can use my name and today's date.
[CUSTOMER][POSITIVE] OK. Thank you very much. Bye bye. That's it.
[AGENT][POSITIVE] Bye bye. You have a good day. Thank you for calling APL, Adam.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What's the error?