AccountId: 011433970860
ContactId: 89f993d3-18e4-4ea7-8137-07232f823ae8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 401899 ms
Total Talk Time (AGENT): 99579 ms
Total Talk Time (CUSTOMER): 95959 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/89f993d3-18e4-4ea7-8137-07232f823ae8_20250306T17:04_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Hi, I'm [PII]. How are you doing today?
[AGENT][POSITIVE] I'm good. How about you, Miss [PII]?
[CUSTOMER][POSITIVE] I'm good and thank you so much for asking. I need to know on the claim status. Could you please help me on that?
[AGENT][NEUTRAL] Sure, I can assist you with claim status, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, the patient's policy number is 02350204.
[AGENT][NEUTRAL] OK. And where are you calling from from my location?
[CUSTOMER][NEUTRAL] From from provider service from University of Chicago.
[AGENT][NEUTRAL] University of Chicago.
[AGENT][NEUTRAL] OK. OK. Thank you. One moment, let me pull this policy, OK?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The name is [PII] to that, and the patient's date of birth is [PII].
[AGENT][NEUTRAL] OK, so that's dependent. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It's [PII] and the total charge amount is $431 even.
[AGENT][NEUTRAL] OK, [PII], correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, OK.
[AGENT][NEUTRAL] If it
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] For this one, the claim, initially, the claim got denied and we have submitted the corrected claim by changing the procedure code from the diagnosis code, we have changed it. Uh, primary diagnosis code we have changed, but it got denied as duplicate. So could you please verify it?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I got denied as a duplicate is because office visits are not covered by the policy. So, uh, it's still an office visit, so it's still gonna be denied with the same denial reason because it's still a same claim for an office.
[AGENT][NEUTRAL] So that's why it was denied as a duplicate.
[CUSTOMER][NEUTRAL] Um, but we have changed the diagnosis code, right?
[AGENT][NEUTRAL] The diagnosis cost has nothing to do with the denial reason. The denial reason is because it's an office visit and office visits are not covered by the policy.
[AGENT][NEUTRAL] The the diagnosis code it's not the reason of the denial, it's the office visit.
[CUSTOMER][NEUTRAL] Just give me a moment.
[CUSTOMER][NEUTRAL] Uh, it's not covered by, uh,
[CUSTOMER][NEUTRAL] By your uh policy, right?
[AGENT][NEUTRAL] Patience.
[AGENT][NEUTRAL] Yes, under the patient's plan. Mhm. Correct.
[CUSTOMER][NEUTRAL] By patient's plan.
[CUSTOMER][NEUTRAL] Uh, but we did not receive a scanned image or EOB setting like that.
[AGENT][NEUTRAL] So you did not receive the original claim EOB?
[CUSTOMER][NEUTRAL] Um, no.
[AGENT][NEUTRAL] OK, and what is the fax number?
[CUSTOMER][NEUTRAL] Yeah, just a moment. The fax number is
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], sorry, it's [PII].
[AGENT][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] To your attention.
[CUSTOMER][NEUTRAL] Yeah, [PII]
[AGENT][NEUTRAL] OK. All right. Do you mind holding for me while I send this out to you while I got you on the line, Miss [PII].
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, one moment, OK? I'm gonna put you on a brief hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.