AccountId: 011433970860
ContactId: 60a3308c-ef94-493b-8521-823087857e77
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 594700 ms
Total Talk Time (AGENT): 197038 ms
Total Talk Time (CUSTOMER): 85522 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/60a3308c-ef94-493b-8521-823087857e77_20250210T17:21_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling to get status of claims.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status, Miss [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And um Ms. [PII], where are you calling from? What facility or provider?
[CUSTOMER][NEUTRAL] Browarderra Fire Rescue for provider.
[AGENT][NEUTRAL] OK, thank you. And may I have um the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] 01612576
[AGENT][POSITIVE] OK. Thank you one moment.
[AGENT][NEUTRAL] And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Mm thank you and I need the date of service and the amount of the claim.
[CUSTOMER][NEUTRAL] 82,020 24 $870.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] When he
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, it's gonna be a minute. I'm searching.
[AGENT][NEUTRAL] And I just need to let you know that for the future you can check the status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] Yeah let's see.
[AGENT][NEGATIVE] OK, so it looks like we received a claim on [PII], and we processed the claim on [PII], and it looks like it was denied. The denial reason is that the service was surrendered after coverage was terminated.
[CUSTOMER][NEUTRAL] OK. And do you have the termination date?
[AGENT][NEUTRAL] Um, yes, um, this policy was effective on [PII], terminated [PII].
[CUSTOMER][NEUTRAL] OK. And do you have that claim number?
[AGENT][NEUTRAL] Yes, the claim number is 3556736.
[CUSTOMER][NEUTRAL] OK. Are you able to help me with another patient?
[AGENT][NEUTRAL] I'm sure, yes, let me just go ahead and make a note on this one so we can, we can move forward to the next one. OK, one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah, OK, go ahead with the next policy number.
[CUSTOMER][NEUTRAL] 1485121 M as in Mary, L as in Larry, 8.
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] and total charges for $900 or no, hold on a second, is that right? One second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, $900.
[AGENT][NEUTRAL] And you said it was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, it looks like we received the claim [PII], processed on [PII], and the claim was denied. The reason for this denial is the outpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that claim number?
[AGENT][NEUTRAL] OK, that's 354-801-3.
[CUSTOMER][NEUTRAL] OK. And are you able to help with one other patient?
[AGENT][NEUTRAL] Mhm. Sure, let me make a note on this one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, go ahead with the next one.
[CUSTOMER][NEUTRAL] ID number is 01638499 [PII] as in [PII] in [PII].
[AGENT][NEUTRAL] OK. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII] [PII].
[AGENT][NEUTRAL] OK, and what is the date of service in the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] total charges for $874.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this one's been processed uh several times, um, the last 123, the last 45 times is processed as a duplicate, so let me go ahead and pull the original one. OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it's gonna be a minute. I'm waiting on the image on this one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this one was received [PII] and it was processed on [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, and this one was denied, indicating inpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And do you have that claim number?
[AGENT][NEUTRAL] Yes, that is 334-447-7.
[CUSTOMER][NEUTRAL] OK, great. And what is your name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK, is there a reference number to the call?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][POSITIVE] OK, thank you for your help.
[AGENT][POSITIVE] You're welcome and thank you for calling ATL. Have a good day, Ms. [PII].
[CUSTOMER][NEUTRAL] You too. Bye-bye.