AccountId: 011433970860
ContactId: 3504f8fb-a251-4bfa-a211-cdb30929d30f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 265660 ms
Total Talk Time (AGENT): 140590 ms
Total Talk Time (CUSTOMER): 82788 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/3504f8fb-a251-4bfa-a211-cdb30929d30f_20250416T13:57_UTC.wav
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[AGENT][NEUTRAL] For contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. My name is [PII] and I'm calling on behalf of provider's office to check on a claim status. Could you please help me with that?
[AGENT][NEUTRAL] Yes, I can help with the claim status. What is that policy number, please?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] The policy number is 01978581.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][POSITIVE] I appreciate that. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Of course it is [PII] and this is my direct line so I do not have an extension.
[AGENT][NEUTRAL] OK, thank you. And what is the uh data service for these?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The date of service is mm.
[CUSTOMER][NEUTRAL] [PII] with the billed amount of $73,0071 even.
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][POSITIVE] OK, thank you. [PII]. OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And I'm sorry, [PII], do you mind giving me the billed amount just one more time, please. I appreciate it.
[CUSTOMER][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] 73071.
[AGENT][POSITIVE] I appreciate that. Thank you.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] OK, I don't, I don't have your
[AGENT][NEUTRAL] Your claim on file, but I will tell you um that her benefits for [PII] were exhausted by the time uh by uh let me see when this last claim was.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] She used all of her all of her benefits by [PII]. Um, now, the policy will uh pick up the deductible, co-payment or co-insurance.
[AGENT][NEUTRAL] Up to $2250 per calendar year and that's just a verification of the benefits, not a guarantee of payment, but she had used all of her calendar year benefits.
[AGENT][NEUTRAL] Um, before this service date now as I mentioned before, I don't have your, your claim on file. It's, it's not showing up being on file, but um if you wish to submit it to us, you can, uh, but it's going to be denied because the um.
[AGENT][POSITIVE] The benefits were already used.
[AGENT][NEUTRAL] By the time that, by the time of this service date.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK. So basically, it is, uh, I mean, the member does not have
[CUSTOMER][NEUTRAL] Any uh coverage on the data service, right?
[AGENT][NEUTRAL] That's correct. Now, I will tell you that we did have a claim for that, uh, for that exact amount on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now, on [PII], we had a claim for that amount and the claim number for that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's 351.
[AGENT][NEUTRAL] 776-6 and that was for 7,307.
[AGENT][NEUTRAL] $71 and no cents. Um, and that was [PII], but, um, again, she had used all of her benefits.
[AGENT][NEUTRAL] By the time that we received that claim.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, no problem. And uh when did you say uh the benefit was exhausted?
[AGENT][NEUTRAL] On, uh, on [PII], excuse me, I'm sorry, on [PII], she used all of her benefits for that calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, thank you very much. So,
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][POSITIVE] All right then, thank you very much. And I'm so sorry. I didn't get your name in the beginning of the call. Could you please help me with your name again?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII].
[AGENT][NEUTRAL] And we will use that in today's date as a reference. Is there anything else that I can help with?
[CUSTOMER][POSITIVE] Uh, well, that would be all for now, [PII]. Thank you very much and you have a wonderful day then. Bye for now.
[AGENT][POSITIVE] OK, thank you for contacting ATL.