AccountId: 011433970860
ContactId: 7775fd7a-071b-4cbb-9c7f-4014011c2c61
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 268559 ms
Total Talk Time (AGENT): 107332 ms
Total Talk Time (CUSTOMER): 82088 ms
Interruptions: 0
Overall Sentiment: AGENT=2.3, CUSTOMER=2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/7775fd7a-071b-4cbb-9c7f-4014011c2c61_20250523T15:43_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Southwest Surgical Associates, and I need help with a claim, please.
[AGENT][NEUTRAL] OK, sure, I can assist you with claims and you say your name is [PII]?
[CUSTOMER][NEUTRAL] With B
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][POSITIVE] Thank you. And may I have a callback number just in case we get disconnected?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] 01612917.
[AGENT][NEUTRAL] Yeah, may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It's uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $435 435.
[AGENT][NEUTRAL] OK. Let me see if I can find this claim for you. And for future, you can check claim status online through our website at [PII]. You're welcome. And let me see if this is your claim.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] reading on the system.
[CUSTOMER][POSITIVE] Mhm take your time no worries.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK. Uh, we processed the claim [PII] and the claim was denied. The reason for this denial is that office visits are not covered by the policy and service rendered in office is not covered.
[CUSTOMER][POSITIVE] So what this means that it can build up we can build the patient?
[AGENT][NEUTRAL] It's really up to the provider's discretion. We don't have any contractual involvement on the remaining, but it's not payable under this policy. So you can go back to the major medical decisions.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm, because of the members plan it's not covered, correct?
[AGENT][POSITIVE] Mhm. Correct, yes, that is correct.
[CUSTOMER][POSITIVE] Uh, thank you so much. Can you please repeat one more time the um the portal?
[AGENT][POSITIVE] Oh, yes, that is, yes, no problem. That is secured.
[CUSTOMER][NEUTRAL] So in the future,
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][POSITIVE] Perfect thank you so much. Can you please provide me uh with your caller reference number please?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] We don't have reference numbers. If you use my name in today's date, if you will, do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, can you please provide me with your name? I didn't catch up the first time. I'm so sorry.
[AGENT][NEUTRAL] Mm, yes, it's OK. My name is [PII]. That's [PII].
[CUSTOMER][POSITIVE] Thank you so much so.
[AGENT][POSITIVE] You're welcome. Thank you for calling APO. You have a good day, Miss [PII].
[CUSTOMER][POSITIVE] You as well thank you bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] OK.