AccountId: 011433970860
ContactId: 8f674182-3943-4c04-ad4e-69cc23996723
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 268420 ms
Total Talk Time (AGENT): 69104 ms
Total Talk Time (CUSTOMER): 81736 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/8f674182-3943-4c04-ad4e-69cc23996723_20250422T17:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. I'm calling from the provider's office that is ophthalmology consultant. Actually, I just need some assistance with one of my claims. Could you please help me in that?
[AGENT][POSITIVE] I'm happy to check on a claim for you. Do you have the patient's policy number?
[CUSTOMER][POSITIVE] Yes, whenever you're ready.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That would be 021.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] 91743.
[AGENT][NEUTRAL] And can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. So the name of the patient is [PII], and the date of birth would be [PII].
[AGENT][NEUTRAL] Thank you and then what's the date of service?
[CUSTOMER][NEUTRAL] Sure. So the date of service would be [PII]. And the total bill amount was of $410.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And it was $310 was the bill amount, is that correct?
[CUSTOMER][NEUTRAL] No, that was 410.
[AGENT][NEUTRAL] 40.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you have an amount after the primary paid that's different?
[CUSTOMER][NEUTRAL] Let me just recheck that.
[CUSTOMER][NEUTRAL] Actually, the primary left the um
[CUSTOMER][NEUTRAL] PR and uh deductible for, let me just, give me a quick second, please. Let me just verify that.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] That would be $135.34.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, I'm not showing any claims on file for that billed amount, just one for that date of service, but it shows a billed amount of 340 34, so I don't believe that's the right claim.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. All right. Cause we do have received the payment for this one. I don't have the claim number as for now. I just wanted some clarification regarding that. So, um, in that case,
[AGENT][NEUTRAL] It's a payment for $60.34?
[CUSTOMER][POSITIVE] Yes, yes, correct.
[AGENT][NEUTRAL] OK, so that claim, it looks like part of it was denied.
[AGENT][NEUTRAL] Um, office visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then there was a benefit payment sent for the $60.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I just wanted the clarification regarding the denial. Thank you so much for that, [PII]. And uh could you also help me with the call reference for this one, please?
[AGENT][NEUTRAL] Call references my name with my last initial than today's date. My name is [PII], that's [PII] Last initial is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right. Thank you so much for that, [PII]. Have a great day ahead.
[AGENT][NEUTRAL] You too [PII]. bye bye.
[CUSTOMER][NEUTRAL] Bye bye.