AccountId: 011433970860
ContactId: 62444a67-90c4-4091-80b2-c0198a01ac0d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1038010 ms
Total Talk Time (AGENT): 186969 ms
Total Talk Time (CUSTOMER): 372062 ms
Interruptions: 12
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/62444a67-90c4-4091-80b2-c0198a01ac0d_20250404T21:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] Hello ma'am. My name is [PII]. Initial of my last name is. I am calling to you from provider office clear Lake Specialties. I need general claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status and can you spell your first name?
[CUSTOMER][POSITIVE] I can help you with that.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes sir, can you spell your first name for me and give me your callback number?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. Initial of last name is [PII], and the callback number is [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sorry, and then what is the
[CUSTOMER][NEUTRAL] and
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm let me check.
[CUSTOMER][NEUTRAL] The member ID number is 02556561.
[CUSTOMER][NEUTRAL] And remember, last name is [PII], and first name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] OK. Let me look up that policy real quick.
[CUSTOMER][NEUTRAL] But to look up that policy real quick.
[AGENT][NEUTRAL] Alright, and then what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Alright, and then what is the date of
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The date of service is [PII] and bill amount is $507 even.
[AGENT][NEUTRAL] OK, and what is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Clear Lake specialties.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim and I will be right back.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] and not.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 2031926.
[CUSTOMER][NEUTRAL] Hello, ma'am, can you repeat? Your voice is not clear.
[AGENT][NEUTRAL] Yes, um, the claim number is 357.
[CUSTOMER][NEUTRAL] Yes, um, the
[CUSTOMER][NEUTRAL] 357
[AGENT][NEUTRAL] 365 8.
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] Claim was paid $100.
[CUSTOMER][NEUTRAL] I can just pay $100.
[AGENT][NEUTRAL] With check number 203.
[CUSTOMER][NEUTRAL] That number 03.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the check cleared the bank.
[CUSTOMER][NEUTRAL] And that clears the bank.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Mm, OK, and claim receipt date, ma'am, please.
[AGENT][NEUTRAL] Let me get that for you.
[AGENT][NEUTRAL] A claim was reported on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Uh, claim was reported on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, I have uh one more claim, same patient.
[AGENT][NEUTRAL] OK, and what is the date of service?
[CUSTOMER][NEUTRAL] Date of service is [PII] and total charges amount is $176 even.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look that one up. I'll be right back.
[CUSTOMER][NEUTRAL] OK, so it's cold.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me. I have this claim ready for you now.
[CUSTOMER][NEUTRAL] Yes, the number is 35.
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] 5436.
[CUSTOMER][NEUTRAL] 543 6
[AGENT][NEUTRAL] The claim was denied because the benefit was maxed for the date of service.
[CUSTOMER][NEUTRAL] The claim was denied because the benefit was back on the date of service.
[AGENT][NEUTRAL] And the received date is?
[CUSTOMER][NEUTRAL] And the receipt date is.
[AGENT][NEUTRAL] Uh, [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Uh, [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Ma'am, uh, the claim number is 357-543-6. Is that right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEGATIVE] OK, and denial reason, uh, again please, I didn't understand for my denial.
[AGENT][NEUTRAL] Yeah, because the benefit was maxed for the date of service.
[CUSTOMER][NEGATIVE] Because the benefit was not for the day of service.
[AGENT][NEGATIVE] It was exhausted.
[CUSTOMER][NEUTRAL] It was
[CUSTOMER][POSITIVE] The benefits was OK.
[CUSTOMER][NEUTRAL] So now I have the next um decision for this claim.
[CUSTOMER][NEUTRAL] Any idea for your rifle?
[AGENT][NEGATIVE] Uh, no.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] I don't, I can't advise on what you should do with your claim with the billing part of it.
[CUSTOMER][NEUTRAL] I don't, I can't.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK benefits or not. OK, so I, I have one more claim for same member.
[AGENT][NEUTRAL] OK, and what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The date of service is [PII] and total charges amount is $194 even.
[AGENT][NEUTRAL] OK, quick hold again I'm gonna look this one up and I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Drama.
[AGENT][NEUTRAL] Mama.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you. I've got this claim ready for you.
[CUSTOMER][POSITIVE] Yes, I'm ready.
[AGENT][NEUTRAL] The claim number is 357.
[CUSTOMER][NEUTRAL] The claim number is 35.
[AGENT][NEUTRAL] 3655.
[CUSTOMER][NEUTRAL] 55.
[AGENT][POSITIVE] Claim was reprocessed, well received on [PII].
[CUSTOMER][NEUTRAL] Claim was received on [PII].
[AGENT][NEUTRAL] Processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was denied because durable medical equipment is not covered under the patient's policy.
[CUSTOMER][NEUTRAL] And the claim was denied because durable medical equipment was not.
[AGENT][NEUTRAL] So it's a non-covered service.
[CUSTOMER][NEUTRAL] Can you repeat? no OK no covered sir.
[CUSTOMER][NEUTRAL] OK, your name, ma'am please.
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and initial last name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and this number?
[AGENT][NEUTRAL] You can use my name and today's date.
[CUSTOMER][NEUTRAL] My
[CUSTOMER][NEUTRAL] And OK, and uh then please confirm the corrective claim can be filing.
[AGENT][NEUTRAL] We do not have one.
[CUSTOMER][NEUTRAL] not have one
[CUSTOMER][NEUTRAL] Anytime I have submitted to the.
[CUSTOMER][NEUTRAL] Uh, anytime I have correction for this claim.
[AGENT][NEUTRAL] Uh, there's no timely, uh, filing limit for a correction, but you'll need a letter as to why the claim needs to be corrected.
[CUSTOMER][NEUTRAL] Uh, there's no time like, uh, 5.
[CUSTOMER][NEUTRAL] Why
[CUSTOMER][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] OK, so, uh, no, I have the
[CUSTOMER][NEUTRAL] Mm, pay ID please.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] And mailing address?
[AGENT][NEUTRAL] You there?
[CUSTOMER][NEUTRAL] Claim mailing address.
[AGENT][NEUTRAL] Yes, it is [PII].
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 950
[AGENT][NEUTRAL] That's in [PII].
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, last time I had, uh, calling to your insurance and, but, uh, the
[CUSTOMER][NEUTRAL] Last time, the ID, he told me the payer ID is 64556 and mailing address is [PII].
[CUSTOMER][NEUTRAL] What
[AGENT][NEGATIVE] No, that's not correct.
[CUSTOMER][NEUTRAL] So that's not
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you for your assistance. Have a nice day.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] No, thank you for your assistance.
[AGENT][POSITIVE] You're very welcome. I hope you have a wonderful day and thank you for calling APL.
[CUSTOMER][POSITIVE] You're very welcome. I hope you have a wonderful day. Thank you for calling. OK, have a nice weekend.
[AGENT][POSITIVE] You too. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] OK bye bye.