AccountId: 011433970860
ContactId: 5395b653-c4d6-43ac-8b25-43becbe620f3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 674739 ms
Total Talk Time (AGENT): 203916 ms
Total Talk Time (CUSTOMER): 232671 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/5395b653-c4d6-43ac-8b25-43becbe620f3_20250415T13:26_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office. And may I know your last name initial?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][POSITIVE] Thank you. And it's like [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], how may I assist you today?
[CUSTOMER][NEUTRAL] Check on the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] 2.
[AGENT][NEUTRAL] And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It is 02052175.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] So, it's [PII]. Date of birth [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The date of service of the claim is [PII]. Bill amount $120 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] And actually, I'm sorry, I have 4 times to check today.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] M G Medical Center.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] The claim number is 3469428.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] As office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So could you fax a copy of your be?
[AGENT][NEUTRAL] Yes, so you need a fax of all the claims we go over today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] And what's a good fax number for you?
[CUSTOMER][NEUTRAL] Uh, give me a second.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And would that be attention, [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's X as in X-ray 1012.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, this is what it should be the attention to or what is this number?
[CUSTOMER][NEUTRAL] Attention.
[AGENT][NEUTRAL] OK, so attention X like X-ray 1012701231?
[CUSTOMER][NEUTRAL] Yeah, with uh American public like. Yeah.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Put I'm sorry, put APL at the end.
[CUSTOMER][POSITIVE] Yeah. A be under this number I gave you right.
[AGENT][NEUTRAL] OK, I'm confused. So we are APL. Are you wanting me to put attention to APL in the fax to you?
[CUSTOMER][NEUTRAL] Uh, with the number I gave you, right, with that number, including APL at the end.
[AGENT][NEUTRAL] The APL thing, OK.
[CUSTOMER][NEUTRAL] The number and APS that's it.
[AGENT][NEUTRAL] And would that be the same for all the explanation of benefits that I'm sending to you?
[CUSTOMER][NEUTRAL] The number will be differ.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have any other claims for this member?
[CUSTOMER][NEUTRAL] I mean,
[CUSTOMER][NEUTRAL] Uh, one second, may I know the call reference number for this number.
[AGENT][NEUTRAL] The call reference number for the entire call will be my name and today's date.
[CUSTOMER][NEUTRAL] OK, one second, let me check.
[CUSTOMER][NEUTRAL] The next
[CUSTOMER][NEUTRAL] Yeah, the next number is under the same patient.
[AGENT][NEUTRAL] OK. So let me, hold on. Let me stop these notes. What's the next date of service?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, one second, it's loading.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] With the amount of.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 268.
[AGENT][NEUTRAL] $268?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][POSITIVE] I thank
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alright, so I'm showing this claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 34885005.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Code 99214 was denied because office visits are not covered on this policy.
[AGENT][NEGATIVE] And code 93,000 was denied because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, may I give you the attention to this number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] It's X1013207.
[CUSTOMER][NEUTRAL] 149.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And APL at the end?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Do you have any other claims for this member?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Are all 4 claims for this member?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The, uh, no, the last one will beer.
[AGENT][NEUTRAL] OK, what's the next data service for this member?
[CUSTOMER][NEUTRAL] [PII]. Will the amount is 268.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what was the total bills?
[CUSTOMER][NEUTRAL] 268
[AGENT][NEUTRAL] 268. OK, hold on one moment. And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm not showing up a claim with the total bill of $268. Is there another total bill that can be, because we only have one claim for that data service.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] With the 260, you don't have any claims?
[AGENT][NEUTRAL] And can you
[AGENT][NEUTRAL] Can you um verify the name of the provider's office?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is Mlo Cardiology Associates.
[AGENT][NEUTRAL] Yes, so there's no claim on file for that data service and total bill from your provider.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, give me a second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So, may I know the effective date of December?
[AGENT][NEUTRAL] The policy has been effective since [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Monday.
[CUSTOMER][NEUTRAL] Uh, OK, and the pay ID?
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] Family planning limit.
[AGENT][NEUTRAL] Um, there's no timely filing as long as the policy is active on the data service. You can file at any time.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me a second.
[AGENT][NEUTRAL] And hold on one moment, I'm faxing this over and then we can move to the last patient.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, and thank you so much for your assistance. Have a good day.
[AGENT][NEUTRAL] OK, you don't have another claim?
[CUSTOMER][NEUTRAL] I know.
[AGENT][POSITIVE] OK, well, I'm sending the explanation of benefits over to you now for this um member. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I know.
[AGENT][POSITIVE] Alright, well thanks so much for calling APL [PII]. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.