AccountId: 011433970860
ContactId: 8991a984-a3d7-42fa-9af1-33efe57b27e7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 318579 ms
Total Talk Time (AGENT): 132793 ms
Total Talk Time (CUSTOMER): 84471 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/8991a984-a3d7-42fa-9af1-33efe57b27e7_20250423T16:53_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from provider's office. Can you help me with the claim?
[AGENT][NEUTRAL] What is your name again, please?
[CUSTOMER][NEUTRAL] And it spells [PII].
[AGENT][NEUTRAL] OK, and your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What is the policy number, please, right?
[CUSTOMER][NEUTRAL] It's 0226595.
[AGENT][NEUTRAL] 02265950, is that correct?
[CUSTOMER][POSITIVE] Yes, correct. Yes, that's correct.
[AGENT][NEUTRAL] Thank you, verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] [PII], and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for the verification process. You're calling for claim status. I can help you with this claim status. Um, you can also check claim status by visiting our secure portal at [PII]. What is the date of service and the total charge amount?
[CUSTOMER][NEUTRAL] [PII] and the charge amount is $619.55. 619.55.
[AGENT][NEGATIVE] Your voice was breaking up.
[AGENT][NEGATIVE] Your voice is breaking up, if you can repeat that.
[CUSTOMER][NEUTRAL] Uh, I will repeat that.
[CUSTOMER][NEUTRAL] Yes, uh, data services [PII] with a charged amount of $19.55. 19.55.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, I do not show the claim on this policy number. One moment, let me check the eligibility for this policy. One moment.
[AGENT][NEUTRAL] OK, this policy shows it termed as of [PII]. The claim is not under this policy. Uh, [PII], give me one moment. Let me check to see if there's an active policy for the member, please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, I do find a policy number active and that policy number when you're ready.
[CUSTOMER][POSITIVE] Uh, yes, I'm ready.
[AGENT][NEUTRAL] 0255.
[AGENT][NEUTRAL] 623 5 ML.
[CUSTOMER][NEUTRAL] Uh, can you please repeat that once again?
[AGENT][NEUTRAL] Yes, it is 02556235.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and this policy became effective as of [PII] and one moment, let me check for that date of service. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You said that was 619 and 5566 1955.
[AGENT][NEUTRAL] I do not show a claim on file for that amount.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, we have received an UB and payment also for this claim.
[AGENT][NEUTRAL] OK, what is the ELB?
[AGENT][NEUTRAL] Claim number?
[CUSTOMER][NEUTRAL] Uh, claim number, claim number is 3582335.
[AGENT][NEUTRAL] 2335. OK, one moment.
[AGENT][NEUTRAL] OK, so that claim was processed on [PII].
[AGENT][NEUTRAL] I see a payment of $114.08 and how can I help you with this claim, please? Thank you for that information.
[CUSTOMER][NEUTRAL] Uh, line item one that is 99213-25 is the night stating that the charges are. Can you please verify what the charges are.
[AGENT][NEUTRAL] The charges are not covered because office visits are not covered by this policy.
[AGENT][NEUTRAL] This policy does not cover office visits.
[CUSTOMER][NEUTRAL] OK. um I'll wait for this.
[AGENT][NEUTRAL] I'm sorry, you want to know the denial date?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] OK. Um
[CUSTOMER][NEUTRAL] A reference number for the call.
[AGENT][NEUTRAL] My name, [PII], last initial L like [PII], and today's date, right? Anything else I can assist you with, please? I'm sorry.
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day bye.
[CUSTOMER][NEUTRAL] Same to you