AccountId: 011433970860
ContactId: 385fd423-9629-4542-925b-f9a5f4685392
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313329 ms
Total Talk Time (AGENT): 122507 ms
Total Talk Time (CUSTOMER): 104293 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/385fd423-9629-4542-925b-f9a5f4685392_20250312T18:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from the provider's office to check on the claim status. Could you please assist me?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Of course I can help you uh with that claim. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. My callback number is [PII] with an extension [PII].
[AGENT][NEUTRAL] OK, thank you. And then did you have that policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes. The policy number is 2 I'm sorry, it is 02440306.
[AGENT][NEUTRAL] OK, and uh what was the name and date of birth for the insured, please?
[CUSTOMER][NEUTRAL] Sure. The member's name is [PII].
[CUSTOMER][NEUTRAL] I just spell it. The first name is [PII], and the last name is [PII].
[CUSTOMER][POSITIVE] And [PII]. I'm sorry for that.
[AGENT][NEUTRAL] That's OK, um, and then did you have that date of birth, please?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Sure, date of birth is on [PII].
[AGENT][POSITIVE] Perfect. Thank you so much for verifying that information, [PII]. Uh, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Yeah, the date of service is on [PII] and I do have two charge amounts here. The first one is 1200 and, yes, please proceed.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, go ahead, that's fine. 0, 1200.
[CUSTOMER][NEUTRAL] $29 even. And another one is the $2480 even. 248 0.
[AGENT][NEUTRAL] 8
[AGENT][NEUTRAL] Got it. OK, and that was, uh, both of those were for [PII], correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] Yeah, uh, memory, could you please tell me your name?
[AGENT][NEUTRAL] Sure, it's [PII]
[CUSTOMER][NEUTRAL] And last name you said is that?
[AGENT][NEUTRAL] No, uh, last initial is A.
[CUSTOMER][NEUTRAL] It's yeah, [PII], isn't it?
[AGENT][POSITIVE] [PII], yes, correct.
[CUSTOMER][POSITIVE] Yeah, thank you. Thank you so much.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yes, OK, so I did find the claim for $1,229. Uh, we were unable to pay that benefit as their outpatient benefit for the calendar year had been met.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's probably the case for this other one, but let me check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, OK, so we received that claim as well. That denial reason is the same that outpatient benefit for the calendar year had been met.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I've got both of those claim numbers uh whenever you're ready.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] For the first one I think, isn't it?
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Mhm. The first one was the one for 1,229. Um, that claim number is 3556.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 455.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, um, did you need when we received it and when it was processed?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this claim was received, uh, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] 7
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and then, mhm.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah. Uh, can you please fax me the copy of the IP for both these claims?
[AGENT][POSITIVE] Of course, absolutely.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What was that fax number for you?
[CUSTOMER][NEUTRAL] Yes. My fax number is [PII].
[CUSTOMER][NEUTRAL] And with attention to my name, [PII].
[AGENT][NEUTRAL] OK, I'm gonna read that number back to make sure I heard that correctly. That was [PII].
[AGENT][NEUTRAL] Hello [PII], can you hear me?
[AGENT][NEUTRAL] Hello?
[AGENT][NEGATIVE] [PII], if you can hear me, I am unable to hear you um I'm going to hang up and I'll give you a call right back.