AccountId: 011433970860
ContactId: 60f34112-91a8-4d9e-9e6b-943387ca9c24
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 604380 ms
Total Talk Time (AGENT): 146269 ms
Total Talk Time (CUSTOMER): 147207 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/60f34112-91a8-4d9e-9e6b-943387ca9c24_20250613T16:54_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. My name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Uh, this is [PII] from American Family Care. I want to check the claim status of the patient.
[AGENT][POSITIVE] I'd be happy to assist with claim status today, [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] The policy number is 02543607.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] The, the patient's name is [PII] and the last name is [PII]
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information and what is the date of service for the claim?
[CUSTOMER][NEUTRAL] Uh, that is [PII].
[CUSTOMER][NEUTRAL] And uh the bill amount is $285 even.
[AGENT][NEUTRAL] And your tax ID.
[CUSTOMER][NEUTRAL] Tax ID is [PII].
[AGENT][POSITIVE] Thank you for that one moment.
[AGENT][NEUTRAL] I'm showing the claim was denied because wellness screenings are not covered under the policy.
[CUSTOMER][NEUTRAL] Uh, it was received on?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Claim was received on [PII]. Claim denied on [PII].
[CUSTOMER][NEUTRAL] Offer [PII] or [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, what's the denied reason? Can you say one more time?
[AGENT][NEUTRAL] Wellness test are not covered under the policy.
[CUSTOMER][NEUTRAL] OK, uh, is it the patient responsibility?
[AGENT][NEUTRAL] We don't determine patient responsibility.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I have claim number?
[AGENT][NEUTRAL] Claim number is 353-3346.
[CUSTOMER][NEUTRAL] 353-334-6, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Uh, may I get call reference for this?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII] [PII], and the date and time of the call. Was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] I have one more claim. Can you assist with that?
[AGENT][NEUTRAL] Is it the same patient or a different patient?
[CUSTOMER][NEUTRAL] Uh, different patient.
[AGENT][NEUTRAL] And what's that policy number?
[CUSTOMER][NEUTRAL] Uh, one moment, I'll put it in my system.
[CUSTOMER][NEUTRAL] Uh, the policy is
[CUSTOMER][NEUTRAL] D. 476-834-11.
[AGENT][NEUTRAL] OK, that's their wellness policy number. I can't pull up the um the policy by that. Do you have a social?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, I have.
[CUSTOMER][NEUTRAL] Uh, the social security number is [PII].
[AGENT][NEUTRAL] OK, it looks like they must not be the primary insured because that is not in our system. What is the name of the patient?
[CUSTOMER][NEUTRAL] The patient's name is [PII] last name [PII] [PII]
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][POSITIVE] Thank you for that one moment.
[AGENT][NEUTRAL] And what's the day service for the claim?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] And the tax ID.
[CUSTOMER][NEUTRAL] The tax ID is [PII].
[AGENT][NEUTRAL] OK, it looks like we received this claim 3 times. The first time a payment was made.
[AGENT][NEUTRAL] Hold on a minute.
[AGENT][NEUTRAL] I do.
[AGENT][NEGATIVE] It looks like a payment was made and then it was voided.
[CUSTOMER][NEUTRAL] Uh, may I get the reason why it was dead?
[AGENT][NEUTRAL] Oh, and then they.
[AGENT][NEUTRAL] Wait, no, that's a different.
[AGENT][NEUTRAL] Sometimes not.
[AGENT][NEUTRAL] OK, so this was paid to the insured.
[AGENT][NEUTRAL] Yeah, the payment for that data service it was paid to the insured.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It was paid to the insured.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Uh, uh, when was the claim received and uh
[CUSTOMER][NEUTRAL] And when it was processed.
[AGENT][NEUTRAL] Let me see [PII].
[AGENT][NEUTRAL] I received the claim [PII] and claim paid on [PII].
[CUSTOMER][NEUTRAL] Uh, [PII], it was received on?
[AGENT][NEUTRAL] [PII] is when we received the claim, claim paid on [PII].
[AGENT][NEUTRAL] But then the claim, then the payment was voided and paid to the insured.
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] Uh, may I get the reason why it was voided and, uh, paid to insured?
[AGENT][NEUTRAL] I don't know.
[AGENT][NEUTRAL] I don't know.
[AGENT][NEUTRAL] Let me check the notes, hold on.
[AGENT][NEUTRAL] The check was returned to us on [PII].
[AGENT][NEUTRAL] And then we reprocessed the claim and paid it to the insured.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] 17
[CUSTOMER][NEUTRAL] 06
[CUSTOMER][NEUTRAL] Mm, I want the reason for that.
[AGENT][NEUTRAL] Well, you'll need to contact the provider to ask why they sent it back.
[CUSTOMER][NEUTRAL] Mm, can I get claim number for this?
[AGENT][NEUTRAL] Same number is 349-720-2.
[CUSTOMER][NEUTRAL] 349 7.
[AGENT][NEUTRAL] 202.
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][POSITIVE] OK, thank you for assisting me. Have a nice day.
[AGENT][POSITIVE] Thank you for calling ACL. Have a good day.
[CUSTOMER][NEUTRAL] Bye.