AccountId: 011433970860
ContactId: 6ac9f690-cfe2-4d03-b99a-d746bb81b2b7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 597140 ms
Total Talk Time (AGENT): 272270 ms
Total Talk Time (CUSTOMER): 202237 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/6ac9f690-cfe2-4d03-b99a-d746bb81b2b7_20250515T19:05_UTC.wav
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[AGENT][NEUTRAL] For contacting ATL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I'm sorry, you sound real muffled. You said your name is [PII]?
[AGENT][NEUTRAL] Yes, my name is [PII]. I'm with ATL. How may I help you?
[CUSTOMER][NEUTRAL] I need it well I'm following up on the claim it denied stating that the patient did not make the premium payment, so I need to follow up on that.
[AGENT][POSITIVE] OK, yes, I can certainly do that. And with whom am I speaking, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], thank you. And what is that policy number that we are looking at today?
[CUSTOMER][NEUTRAL] 250-5485
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] That might be the group membership.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] It has a 0 in the front.
[AGENT][NEUTRAL] Uh, yeah, um, let's see.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] OK, I have to go back and look to it.
[CUSTOMER][NEUTRAL] Looks like he's send it in while he was on the phone, I guess. I don't know, it just looks weird.
[AGENT][NEUTRAL] OK. How do you spell his last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And the first name, please?
[CUSTOMER][NEUTRAL] I guess it's [PII] [PII] is that date of birth.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I can give you the date of service.
[AGENT][NEUTRAL] Yes, and what is that please?
[CUSTOMER][NEUTRAL] [PII] and the total amount uh I think it's 829.
[CUSTOMER][NEUTRAL] But the response that we received um back is that.
[CUSTOMER][NEGATIVE] It was denied due to, it was not covered due to
[CUSTOMER][NEUTRAL] Him not well, basically a lapse in coverage him not having paid his premium, so I just need to confirm.
[AGENT][NEUTRAL] OK. And is this
[CUSTOMER][NEUTRAL] That information or get some eligibility oh go ahead.
[AGENT][NEUTRAL] Sure, absolutely. And are you with the provider? Are you, uh,
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And what, what is that claim number that you received from us?
[CUSTOMER][NEUTRAL] It is, let me see here.
[CUSTOMER][NEUTRAL] 202-409-090145
[AGENT][NEUTRAL] Let me see if I can't find it by his name.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] For his first name.
[CUSTOMER][NEUTRAL] You're spelling his name?
[AGENT][NEUTRAL] Yes, uh, his first [PII]
[CUSTOMER][POSITIVE] It's [PII].
[AGENT][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, I'm looking at the card it's still the same on the card. Mhm.
[AGENT][NEUTRAL] OK, is there a number there that begins with a 01 or 02 or?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Maybe yes.
[CUSTOMER][NEUTRAL] Where at?
[AGENT][NEUTRAL] Maybe on a member number. I see I'm trying to see.
[AGENT][NEUTRAL] I'm just trying to find it by his name. Uh, let's see, maybe this is it.
[AGENT][NEUTRAL] Let me just check here.
[CUSTOMER][NEUTRAL] I have a policy number that's the number I provided to you.
[AGENT][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] And that's the only
[CUSTOMER][NEUTRAL] I mean that's the only number on his card, the 02505485 number that I mean that's what's on his card, his name.
[AGENT][NEUTRAL] OK, [PII], do you mind, do you mind giving me that number again? I'm sorry, what is that again?
[CUSTOMER][NEUTRAL] 02505485
[AGENT][NEUTRAL] OK, let me try that. And while I'm looking at that, while I'm looking that up, if I could just have a callback number please, ma'am, in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Oh, I appreciate that. Thank you. Let's see what we have here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the date of service you said was in August?
[CUSTOMER][NEUTRAL] Give me just a moment. Let me get back. I pulled up his card, um.
[CUSTOMER][NEUTRAL] 84 of 24, so it's 84 of last year. Yes, yes, several claims, but that's the account I have pulled open.
[AGENT][POSITIVE] OK, great.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] So let's see.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] It looks like that yes, these policies are paid uh what they do is they um they get this through their employer and each week the employer sends us something that lets us know that the that the insurer is still with the uh with the uh.
[AGENT][NEUTRAL] Uh, program, you know, they're still there as an employee and that they that they have this insurance, and that's what I'm looking for now, uh, for that data service.
[AGENT][NEUTRAL] OK, let's see
[AGENT][NEUTRAL] So it looks like for that week of service, [PII].
[AGENT][NEUTRAL] Uh, [PII] we didn't receive anything letting us know that that he was with the, uh, that he was still um active with this with this program and sometimes these are um uh the employer is a uh a temporary staffing so let me just see if that is indeed the case because if it is then it probably meant that he you know he just didn't, he was, wasn't available that week and uh that's usually how these things go, but I'm just gonna check here.
[AGENT][NEUTRAL] Because it doesn't show that he was active for that week, and we actually show that the policy is, uh, has lapsed as of now and so let's let me see what we've got here because that's very likely when it's happened which is that he just wasn't, he wasn't active for that week and that's indeed the case.
[AGENT][NEUTRAL] Then he wouldn't, he wouldn't be, uh, this program wouldn't be active for that week.
[AGENT][NEUTRAL] So, um, usually, yeah, so this is like a temporary service and so probably what ended up happening is, uh, that we just did not get the, uh, verification for that week for the week of, of [PII], um, but actually it was from [PII]. It doesn't look like we have anything, um, so, um.
[AGENT][NEUTRAL] Nothing would be available for that week.
[AGENT][NEUTRAL] Now if, if they did send us something letting us know that he was that he had worked that week or that the that the premium has been paid that week, then usually what they will do is they will go ahead and send that electronic filing to us and we will in turn update the the uh system and um pay the claim, but I don't show that we had that so that is what has happened with this. It looks like for that whole week that uh he was not, um, he was not covered and.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] As I mentioned before, his policy actually lapsed now as, as uh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Can you give me his date?
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Can you, can you just give me his policy date? OK.
[AGENT][NEUTRAL] Yeah, absolutely, because his policy was active for um from [PII].
[AGENT][NEUTRAL] To [PII].
[AGENT][NEUTRAL] But it's, this is one of those programs that it goes week by week. So each and every week we have to receive something from his employer letting us know that he's still with the program, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I got it. I'm, I.
[CUSTOMER][NEUTRAL] Oh, OK, I got that part. Um, so the week of it's another one while I'm on the phone, might as well at, there's another one.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, for September date, this one is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me just see if there's what you have for that one. I have, I don't have that account per se open, but I can see it. I can still see it and I just like to, if I get a make a call like, you know, I can, yeah.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh, that's exactly the same thing that we have on that week as well, um, but we just didn't.
[CUSTOMER][NEUTRAL] OK, what's the beginning of the week, so the coverage?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] And it actually
[AGENT][NEUTRAL] Yeah, well, actually I think his policy, uh, I think by that time, [PII], his policy has gone ahead and left. Yeah, this went ahead and turned on the [PII], so.
[CUSTOMER][NEUTRAL] Oh, go ahead.
[CUSTOMER][NEUTRAL] Turned
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yep, OK, I see it now, yep, you did say [PII]. Alright, do you have a call reference for me? So that's his patient responsibility that falls on him.
[AGENT][NEUTRAL] Yes, um, my name is [PII]. The first letter of my last name is [PII], and we're gonna use that today's date as our reference.
[CUSTOMER][POSITIVE] Alright thank you so much [PII].
[AGENT][POSITIVE] OK, thank you for contacting UT.