AccountId: 011433970860
ContactId: 81cac497-6d7e-4e0f-ae89-e18d7b2615d7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 221619 ms
Total Talk Time (AGENT): 102327 ms
Total Talk Time (CUSTOMER): 88081 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/81cac497-6d7e-4e0f-ae89-e18d7b2615d7_20250102T18:47_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, I'm sorry, what was your name?
[AGENT][NEUTRAL] Um, it's [PII], um, it's spelled [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I, yes, I'm trying to first check eligibility and then check claims for the patient.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you with that information. Um, first, could I get your name and a good callback number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] 023890007.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And just submit advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII].
[AGENT][NEUTRAL] The policy is still active, and is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] This is for outpatient clinic doctor's office.
[AGENT][NEUTRAL] OK, for services provided, um, so was it billed with place of service 11?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK. For services provided in the doctor's office, um, our clinic, we cover up to 2000 per calendar year and that's for the co-insurance and the deductible after the primary insurance processes the claim, but the co-pay for the office visit is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said you need to verify the um status of a claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what's the date of service and bill charges?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] $37.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK. Yes, ma'am. We received that claim on [PII].
[AGENT][NEUTRAL] And the claim processed on [PII].
[AGENT][NEUTRAL] The claim number is 346-435-9.
[AGENT][NEUTRAL] And the claim is denying because we need the EOB from the primary insurance company because this is for secondary gaps, so we'll need to see the primary carrier EOB so we'll know how much to pay.
[CUSTOMER][NEUTRAL] Got it, but I don't think there's a primary community care term. It's primary term.
[CUSTOMER][NEUTRAL] So I don't think he's got any other insurance.
[CUSTOMER][NEUTRAL] Uh, from what I can see, I don't see any other insurance, but I didn't think APL would ever be primary. I, I just knew that, but.
[CUSTOMER][NEUTRAL] Somebody else build this so I was just trying to get it all squared away and put it in the right bucket so OK I'll take care of this. I know APL is not primary so.
[AGENT][NEUTRAL] Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, let me just give me one second. I think community care turned on [PII] and this was [PII], so yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK. All right. Thank you. I appreciate it. Thank you. Thanks. Bye. Thank you.
[AGENT][NEUTRAL] OK. You're welcome, [PII]. Thank you for calling APL bye.
[CUSTOMER][NEUTRAL] Bye-bye.