AccountId: 011433970860
ContactId: 5e3617e1-c57a-4aad-a8f6-776f3c785356
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 449839 ms
Total Talk Time (AGENT): 206899 ms
Total Talk Time (CUSTOMER): 146752 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/5e3617e1-c57a-4aad-a8f6-776f3c785356_20250604T14:02_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from Washington state on a denied claim that I received. I just need a little information about the denial and the plan the patient is on.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah, I can get clarification regarding that claim. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh huh [PII].
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] What I have that we're billing with is 02571787.
[AGENT][NEUTRAL] OK, and then, uh, what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Perfect. Thank you for verifying that. Uh, so this policy is a limited indemnity medical plan. Um, what was the uh date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And it's for $374.
[AGENT][NEUTRAL] OK, do you happen to have that claim number?
[CUSTOMER][NEUTRAL] Uh, hang on, let's see, um, I think it was her.
[CUSTOMER][NEUTRAL] We got a letter.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] We're 358-389-5.
[AGENT][POSITIVE] OK, OK, thank you one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I've got this one billed as $265.
[CUSTOMER][NEUTRAL] For for oh wait for [PII]?
[AGENT][NEUTRAL] Uh, the claim number you gave me, that's 358385-95, is that right?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] That's showing a date of service of uh [PII].
[CUSTOMER][NEUTRAL] Oh shoot, oh they got them mixed up. OK, I have that, yes, I have that data service too, [PII], yeah.
[AGENT][NEUTRAL] OK, are we still needing uh clarification for both?
[CUSTOMER][NEUTRAL] Yes, so I mean it, uh, it's gonna probably be the same. It'll probably be the same for both, so, uh, yeah, OK, so yeah, [PII], um, yes, is for $265.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Got it.
[AGENT][NEUTRAL] OK, OK, bear with me just a moment, let me take a look. I just wanted to make sure we were looking at the right thing.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I, I'm not quite sure what you received, um, but I can send you this, uh, we did have an updated uh explanation of benefits regarding this claim, um, so in short it's stating that there was a.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Discrepancy with uh the provider's tax ID number and that we had mailed uh instructions on resolving it um essentially what we get notices from the IRS that it doesn't match uh the name versus the tax ID and there was a procedure that you could go through um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Or a process that you could go through to get that remedied. Uh, however, it looks like we already included the payable benefits to the insured.
[AGENT][NEUTRAL] So to the member.
[CUSTOMER][POSITIVE] OK, so, OK, there was an issue with the 10 and that's resolved that.
[CUSTOMER][NEUTRAL] I guess I, I don't understand, so you already paid benefits to the patient?
[AGENT][NEUTRAL] Yes, according to this information, yes.
[CUSTOMER][POSITIVE] Paid benefits to the patient.
[AGENT][NEUTRAL] Correct. And again if you would like I can send you this um updated explanation of benefits that has all of that information.
[CUSTOMER][POSITIVE] OK, that would be great.
[AGENT][NEUTRAL] Sure, do you have a fax number?
[CUSTOMER][NEUTRAL] We will fax OK uh yes it's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that correctly. That was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alright, and then, um, just for good measure, let's go ahead and check this other, um, claim as well.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you said that was for $374?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess I'm, I'm a little confused because.
[CUSTOMER][NEUTRAL] I someone had called on this one and said that this this uh this patient doesn't have the coverage for they only have coverage for hospital stay or something so they're they, this, yeah.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Uh, so this plan is a little bit confusing. It's as it's a limited indemnity medical plan or it's a hospital indemnity plan is what it's called, but there are further benefits. Um, for example, it looks like for this policy for this kind of what was just an office visit, it looks like urgent care.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, but yeah, in the urgent care, yeah, yeah.
[AGENT][NEUTRAL] Is that right? Yeah, so the benefits payable for that is uh $100 max and that's going to be per uh visit, so it's just that flat amount.
[AGENT][NEUTRAL] So it is a bit different than traditional major medical, um.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] But that $100 went to the patient.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see, give me just a moment. Let me get this other one pulled up. It looks like this one's a similar situation, um, but just so that we can be sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, this one is uh identical to the other one so I can go ahead and uh send you both of these so you've got them.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, that would be great. OK, and then I guess my question uh what is it, what would be the call reference number for today?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Sure, it would be my uh first name, last initial, and today's date. Uh so my name is spelled [PII]
[AGENT][NEUTRAL] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And Thursday that's it. Thank you very much. I appreciate it. I'll wait for the fax.
[AGENT][POSITIVE] All right. Absolutely. Yeah, sorry about the confusion. No problem. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] That's OK thank you you too bye bye.
[AGENT][NEUTRAL] Bye bye.