AccountId: 011433970860
ContactId: 5cdf327f-2102-4b3e-b818-290fe2b9aada
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 354299 ms
Total Talk Time (AGENT): 147498 ms
Total Talk Time (CUSTOMER): 108549 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/5cdf327f-2102-4b3e-b818-290fe2b9aada_20250130T19:51_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office checking on claim status.
[AGENT][NEUTRAL] OK, sure. I can assist you with claiming service, Mr. [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] All right. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, patient policy number.
[CUSTOMER][NEUTRAL] It's 1,404,300 M as in Mike L as in Lima number 8.
[AGENT][NEUTRAL] Is that all the numbers?
[AGENT][NEUTRAL] Can you repeat the number one more time.
[CUSTOMER][NEUTRAL] 1,404,300 M Mike Lima number 8.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It's [PII] Date of birth [PII].
[AGENT][NEUTRAL] OK, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service.
[CUSTOMER][NEUTRAL] It's [PII] with the total bill amount of
[CUSTOMER][NEUTRAL] $350 even.
[AGENT][NEUTRAL] OK. So that was August 1313 of 24, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] OK, for future, you can check claim status online through our website at [PII] and that's just optional. And
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I'm searching for your claim. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEGATIVE] All right, we received the claim [PII], and we processed the claim [PII] and the claim was denied. The reason for this denial is that the service was rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] OK, so the service.
[CUSTOMER][NEUTRAL] Well, can you please provide me?
[CUSTOMER][POSITIVE] The effective and to date of the service.
[AGENT][NEUTRAL] Of the policy, yes, one moment.
[AGENT][NEUTRAL] OK, the policy was effective from [PII] and it terminated [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, got it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it was received on [PII].
[AGENT][NEUTRAL] OK, let me go back to the claim. One moment.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] I had to go back to the claim. I just got out to give you the rest of the information. One moment.
[CUSTOMER][POSITIVE] Oh, OK, no problem.
[AGENT][NEUTRAL] OK, the claim was received [PII], processed [PII].
[CUSTOMER][NEUTRAL] OK. Can you please provide me the policy name?
[AGENT][NEUTRAL] This policy is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] Uh, can you please spell it out, uh, the policy name? Actually, I want to note it down.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] S U T L E M.
[AGENT][NEUTRAL] A N T A L.
[CUSTOMER][NEUTRAL] EAL supplemental.
[AGENT][NEUTRAL] So it's the mental, TAL is the last three.
[CUSTOMER][NEUTRAL] Supplemental, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, it's just supplemental?
[AGENT][NEUTRAL] Yeah, it's a secondary supplemental plan.
[AGENT][NEUTRAL] To the major medical
[CUSTOMER][NEUTRAL] Oh the supplemental plan and is it a PPO HMO or EPO?
[AGENT][NEUTRAL] It's a commercial plan.
[CUSTOMER][NEUTRAL] Commercial plan. OK, got it.
[CUSTOMER][NEUTRAL] Uh, provide me the claim number.
[AGENT][NEUTRAL] All right, the claim number is 3511328.
[CUSTOMER][NEUTRAL] 28. OK, got it. Call reference?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] We don't have reference numbers, you can use my name in today's date.
[CUSTOMER][NEUTRAL] Spell your name for me, please.
[AGENT][NEUTRAL] Sure, that's [PII].
[AGENT][NEUTRAL] Last initial [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, that's all. It's [PII] is the last initial.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK. Thank you so much for your kind information and have a great day. Bye for now.
[AGENT][POSITIVE] You as well. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, thank you so much for the information. Bye. Uh, just wanted to know, is there, is the member does have any other active insurance?
[AGENT][POSITIVE] Mhm, mhm, bye-bye. Thank you for calling ATL.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, he doesn't have, or she doesn't have any other insurance with us after this one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much bye.
[AGENT][POSITIVE] Bye bye. Thank you for calling ATL.