AccountId: 011433970860
ContactId: 3e28132f-a50b-4945-a40e-166a9d86eee5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 438679 ms
Total Talk Time (AGENT): 172920 ms
Total Talk Time (CUSTOMER): 92148 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/3e28132f-a50b-4945-a40e-166a9d86eee5_20250127T13:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] calling from 8 [PII]. I'm calling to check the status of um a medical claim. I have 4 different dates of service for the same patient.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with claim status. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII] and I'm sorry, what was your name again?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] My name is [PII]. Um, it's spelled [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] OK, my last initial is [PII] if you need it.
[AGENT][NEUTRAL] Yes, ma'am. Thank you. And now I need the policy number, please.
[CUSTOMER][NEUTRAL] Yes, it is 993-835-940.
[AGENT][NEUTRAL] OK, that's not one of our policy numbers. Um, I can look them up by name and date of birth. What's the last name?
[CUSTOMER][NEUTRAL] Last name is [PII]
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I found him in our system and I have his policy number here if you'd like that.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Um, his policy number is 02510922.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And um let's see, what's the first date of service?
[CUSTOMER][NEUTRAL] [PII] for $4.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK. Yes, ma'am. We received that claim on.
[AGENT][NEUTRAL] We received that claim on [PII].
[AGENT][NEUTRAL] The claim was processed on [PII].
[AGENT][NEUTRAL] And the claim denied because venal punctures are not covered under the policy, and I have the claim number here.
[AGENT][NEUTRAL] The claim number is.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] The claim number is 3555696.
[CUSTOMER][NEUTRAL] And you said it's not for.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Um, venal punctures are not covered under the policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, and the next date of service is.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] And the bill charges?
[CUSTOMER][NEUTRAL] It is for $249.02.
[AGENT][NEUTRAL] OK, we received that claim on [PII].
[AGENT][NEUTRAL] It processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It paid out for $75 even.
[AGENT][NEUTRAL] The claim number is 3555692.
[AGENT][NEUTRAL] And it paid out that amount because under this policy, we cover up to $75 per office visit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you need the check number?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Um, yes, ma'am, and is the patient responsible for the rest or something we need to write off?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, he's responsible for the rest.
[CUSTOMER][NEUTRAL] OK, yes ma'am.
[AGENT][NEUTRAL] OK. And that check number is.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] 2024369
[CUSTOMER][NEUTRAL] Alright and.
[CUSTOMER][NEUTRAL] Alright, and the next one is for.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, we received this one on [PII].
[AGENT][NEUTRAL] It processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3555697.
[AGENT][NEGATIVE] And it also denied because venal punctures are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I don't know if you have this one on file yet, but [PII] $165.02.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. We have that one. we received that one on [PII].
[AGENT][NEUTRAL] It processed on [PII].
[AGENT][NEUTRAL] The claim number is 3554381.
[AGENT][POSITIVE] And it paid out for $75 even because that's the benefit amount um for office visits. The rest is patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that check number is
[AGENT][NEUTRAL] 202.
[AGENT][NEUTRAL] 3838.
[CUSTOMER][POSITIVE] Alright well thank you so much and you have a great day.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] No ma'am.
[AGENT][POSITIVE] OK. Well, I thank you again, [PII], for calling ATL. You have a great day as well. Mm bye.
[CUSTOMER][POSITIVE] Yes thanks bye bye.
[AGENT][POSITIVE] Thank you