AccountId: 011433970860
ContactId: 464a5b39-2060-40c9-b4af-efe615015431
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 417380 ms
Total Talk Time (AGENT): 228209 ms
Total Talk Time (CUSTOMER): 195098 ms
Interruptions: 8
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/464a5b39-2060-40c9-b4af-efe615015431_20250219T20:41_UTC.wav
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[AGENT][NEUTRAL] Contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm calling from provider office. How are you?
[AGENT][NEUTRAL] I'm fine. How are you?
[CUSTOMER][NEUTRAL] Uh, actually I need to discuss with you some claim status.
[AGENT][NEUTRAL] OK, I can help with the claim. And what is that policy number, please?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, the patient policy number 02152735.
[CUSTOMER][NEUTRAL] On
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The patient name is uh [PII].
[CUSTOMER][NEUTRAL] And the date of birth is on [PII].
[AGENT][NEUTRAL] Thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][POSITIVE] Thank you. And what is
[CUSTOMER][NEUTRAL] And my extension is a yeah.
[AGENT][NEUTRAL] Oh, I'm sorry, what is your extension? I'm sorry, [PII].
[CUSTOMER][NEUTRAL] It's a 1511.
[AGENT][POSITIVE] Great. I appreciate that. What date of service are we looking for for a moment?
[CUSTOMER][NEUTRAL] Actually actually I have a multiple data services for this patient. The first one is a 9-17, 2024. The bill amount is $88.03 and the second date of service is in [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The bill amount is $401.06 and the last date of service is [PII].
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $88.03.
[AGENT][NEUTRAL] OK. Well, let's look at the first one,
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Now, the uh.
[CUSTOMER][NEUTRAL] No, no, it's a [PII].
[AGENT][NEUTRAL] Excuse me, I'm sorry, [PII] for $88.03.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Um, that, that claim number.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Is 355.
[AGENT][NEUTRAL] 3716.
[AGENT][NEUTRAL] And it looks like this is for an office visit, um, and also, uh, some procedures in the, in the uh physician's office. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. So this is a secondary or gap insurance and it's meant to pick up the deductible, co-payment or co-insurance from their major medical. But the only services that it covers, uh, are, are, um, hospitals. So it doesn't cover anything within the physician's office. It doesn't cover the office visit. It doesn't cover the, um, uh treatment within the physician's office. It doesn't do any of those things at all. Um, so, let me just check here. Yeah.
[CUSTOMER][NEUTRAL] uh.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so it doesn't.
[CUSTOMER][NEUTRAL] Doesn't cover any physician office services.
[AGENT][NEUTRAL] No, it doesn't look like it covers any of that. Um, I'm just checking here to be absolutely certain, yeah. So it's just, it's just, um, hospital, um.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] So the claim 35537.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] 16 for [PII]. We received that claim.
[CUSTOMER][NEUTRAL] I think.
[AGENT][NEGATIVE] On the [PII], we processed it on the [PII]. It was denied uh because the, the uh policy just doesn't cover uh anything within a physician's office.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, and so that's, uh, that was not going to be covered. Now, the next
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you, you are only, you are only covered the hospital uh benefits.
[AGENT][NEGATIVE] That's correct, yes. So there's, there's absolutely no uh uh um benefits.
[CUSTOMER][NEUTRAL] As a primary or secondary?
[AGENT][NEUTRAL] Well, we're the secondary insurance.
[CUSTOMER][NEUTRAL] OK, so you, you can cover the.
[CUSTOMER][NEUTRAL] Secondary hospital benefits.
[AGENT][NEUTRAL] Uh, hospital, yes, and that's, but that's it.
[AGENT][NEUTRAL] Now it looks like the second data service that that uh we have um.
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, that, uh, claim number.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] It's 354.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 1751.
[AGENT][NEUTRAL] And we received that claim.
[AGENT][NEUTRAL] On the [PII].
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] We processed it on the [PII], but again,
[CUSTOMER][NEUTRAL] Wait, wait, [PII] and uh process on [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEGATIVE] And it was denied again with the same reason.
[AGENT][NEGATIVE] Exactly, yes. It was, it was denied because uh it's just, these are, these are charges that are just not um.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] We are you offering the provider portal?
[AGENT][NEGATIVE] It's not covered.
[AGENT][NEUTRAL] We do have a provider portal, yes, you, you can go online to find these, uh, this information.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] How can we create the portal?
[AGENT][NEUTRAL] Uh, no, you would do that. You can go online, um, our website is, um.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And uh you can go online, yeah, you can submit the claims.
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh, that's correct, yes. [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, I'll I'll try after this call, OK.
[AGENT][NEUTRAL] And the last date of service.
[CUSTOMER][NEUTRAL] So what about the
[AGENT][NEUTRAL] Yeah, that, that claim number is 355.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Very good
[AGENT][NEUTRAL] 0936.
[CUSTOMER][NEUTRAL] I mean that.
[AGENT][NEUTRAL] We received that claim on [PII] and we processed it.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] On [PII]. But again, [PII], this, this was denied because uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] These services just aren't covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please give me a call reference number?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] We're gonna use that today's date is uh [PII]
[CUSTOMER][NEUTRAL] Could you please spell your name?
[AGENT][NEUTRAL] Why
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][POSITIVE] [PII]. OK, [PII], thank you so much for cooperating with me. Have a wonderful day.
[AGENT][POSITIVE] OK, well, thank you for contacting thanks for contacting ATL. Have a very good day.