AccountId: 011433970860
ContactId: 8e3b524c-4e7b-4100-b74d-06d159c4c79d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287160 ms
Total Talk Time (AGENT): 125511 ms
Total Talk Time (CUSTOMER): 46877 ms
Interruptions: 0
Overall Sentiment: AGENT=2.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/8e3b524c-4e7b-4100-b74d-06d159c4c79d_20250116T19:12_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Atrium Health, and I am calling for claim status.
[AGENT][NEUTRAL] OK, [PII], you said that you're, you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] If I can help you with that, and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEGATIVE] OK, thank you. Now, [PII], we have a bad connection, so I missed part, I wasn't able to understand. Your voice is breaking up. So I heard area code [PII]. I did not hear the next three numbers.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number that you're calling on behalf of?
[CUSTOMER][NEUTRAL] 1451738 ML 8.
[AGENT][NEUTRAL] OK, thank you, [PII]. One moment, please.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, and any information, [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] $9324225. No, I'm sorry, $238.
[AGENT][NEUTRAL] OK. Did you say 93 2024 for $238 is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] OK, so I do see that this claim was received. It was received on [PII]. It was processed and denied on [PII].
[AGENT][NEUTRAL] Uh give me one moment.
[AGENT][NEUTRAL] The claim number on here is 352-633-2.
[AGENT][NEUTRAL] And the reason for the denial, [PII] states that office visits are not covered by the policy.
[AGENT][NEGATIVE] And the other code was denied as this service is not covered when performed in a doctor's office or clinic.
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefits [PII], you should be able to print that from our portal.
[AGENT][POSITIVE] And our website for the portal is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes, ma'am, that is correct. Mhm.
[CUSTOMER][POSITIVE] OK. All right, thank you.
[AGENT][POSITIVE] Well, you are very welcome. So is there anything else that I could help you with today?
[CUSTOMER][NEUTRAL] Um, just the reference number if you have one.
[AGENT][POSITIVE] Yes, ma'am you will actually use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] OK, well, you're welcome and thank you again for calling APL. I hope you have a great afternoon.
[CUSTOMER][NEUTRAL] Alright, you too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.