AccountId: 011433970860
ContactId: 4e06fb0c-c007-44d9-8add-92e9b5f6d153
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 452220 ms
Total Talk Time (AGENT): 210222 ms
Total Talk Time (CUSTOMER): 123628 ms
Interruptions: 5
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/4e06fb0c-c007-44d9-8add-92e9b5f6d153_20250409T17:29_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, I was calling for claim status for a couple of claims.
[AGENT][NEUTRAL] OK, so you're needing claim status. Is it for the same patient with multiple dates of service or different patients?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Same patient.
[AGENT][POSITIVE] OK, yes ma'am. I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] OK, [PII] last initial is [PII]
[AGENT][NEUTRAL] OK, and [PII], the first initial and my last name, if you need that is [PII]
[AGENT][POSITIVE] And what is a good callback number? You're welcome. What is a good callback number for you?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's the first, um, well, yes, go ahead and give me your patient's policy number, [PII].
[CUSTOMER][NEUTRAL] OK, it is 216-656-9.
[AGENT][NEUTRAL] OK, thank you. One moment while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] I mean the information [PII] that I did provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] say nothing
[CUSTOMER][NEUTRAL] So I can't clock out here.
[CUSTOMER][POSITIVE] your computer real quick.
[AGENT][NEUTRAL] OK, and [PII], what is the first date of service for her and total bill amount, please?
[CUSTOMER][NEUTRAL] [PII] 24 $250.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] How are those who's the 30?
[CUSTOMER][NEUTRAL] that real quick.
[CUSTOMER][POSITIVE] They're beautiful.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I can see
[CUSTOMER][POSITIVE] Gorgeous though.
[CUSTOMER][NEUTRAL] I think
[AGENT][NEUTRAL] OK, so I do see that this claim was received, [PII]. The received date on it was [PII], and it was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There has been a benefit paid in the amount $11.19 on this claim.
[AGENT][NEUTRAL] That was
[AGENT][NEUTRAL] Amazon code 81025.
[AGENT][NEUTRAL] And 99214.
[CUSTOMER][NEUTRAL] The phone cut out. Could you repeat that? I heard a.
[CUSTOMER][NEUTRAL] It cut out right after you said $11.
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Oh, OK. $11.19.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then code 992.
[CUSTOMER][NEUTRAL] That's the amount that was paid correct?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the 99214 was denied as office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you did say you had another data service for her also?
[CUSTOMER][NEUTRAL] Yes ma'am, it is for 127 25.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Billed amount is $250.
[AGENT][NEUTRAL] All right, thank you, one moment.
[AGENT][NEUTRAL] OK, so I, and you did say, I just want to clarify, data services 127 of 2025. That's also for [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so we do not have a claim on.
[AGENT][NEUTRAL] File for that data service. Let me just refresh this one more time.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, we do not have a claim on file for her for that data service.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Not for 127.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] And then I'm assuming that you do know to submit the, OK, to also submit a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] In the mail today then.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And do you have our portal website that you
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] You can go to
[AGENT][NEUTRAL] To print this EOD if you need a copy of that.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Now that you have the claim number, we have a portal, [PII]. It's you, it's a self-registering portal.
[CUSTOMER][NEUTRAL] I think I just made a a log in.
[CUSTOMER][NEUTRAL] Oh, that's what it was. I didn't, I couldn't find a claim number for the claim, so I couldn't look it up on there.
[AGENT][NEUTRAL] OK, so right, so you do have the online service center port portal website.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] I, OK. OK.
[AGENT][NEUTRAL] And you have a claim number you should be able to.
[AGENT][NEUTRAL] Locate that and also a lot of people when they're trying to set it up or to use that portal, when it asks for the patient's account number, [PII], and I'm not saying this is the case for you, but that is not our policy number. That is the provider's patient account number. OK, so sometimes people are like, oh, OK, well,
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes I am.
[CUSTOMER][NEUTRAL] Yeah, no, I used our account number.
[AGENT][NEUTRAL] I've been using the policy number for APL, so, OK. All right then. Well, uh, is there anything else there that I can help you with at the moment?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Ay.
[CUSTOMER][NEUTRAL] That is all, um, other than a reference number.
[AGENT][NEUTRAL] Sure, you will use my name along with today's date.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII] you have a good day.
[AGENT][POSITIVE] Well, I hope you do too, [PII]. So again, thank you for calling APL.
[AGENT][POSITIVE] If that's all I can help
[CUSTOMER][POSITIVE] Thank you.