AccountId: 011433970860
ContactId: 948c71e0-2308-4930-9032-eea2c77d43d4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 229660 ms
Total Talk Time (AGENT): 102916 ms
Total Talk Time (CUSTOMER): 82939 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/948c71e0-2308-4930-9032-eea2c77d43d4_20250305T17:40_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] again. How are you doing today?
[AGENT][POSITIVE] Hey [PII], I'm doing well how are you?
[CUSTOMER][POSITIVE] I'm pretty good, [PII]. Thank you so much for asking. And I'm checking on claim status actually.
[AGENT][NEUTRAL] Sure, OK, I could check on a claim for you. um, if I could, can I get a good call back number from you first?
[CUSTOMER][NEUTRAL] [PII] it's a declined.
[AGENT][NEUTRAL] Thank you. And then, uh, do you have that policy number, please?
[CUSTOMER][NEUTRAL] I do, and the policy number what I have in my records is 01677896 and Mary Lima number 7.
[AGENT][NEUTRAL] OK, and then uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Uh, it's for, uh, [PII] with the date of birth [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that [PII] and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Uh, it's [PII] with the bill amount of $365.01.
[AGENT][NEUTRAL] That was $365.01.
[CUSTOMER][NEUTRAL] Yeah, 365.01.
[AGENT][NEUTRAL] OK, thank you for verifying that. Alright, one moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And this was with the same provider, uh, health holdings company.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so we did receive this claim, [PII], so for procedure code 99396, uh, we were unable to pay that benefit as office visits are not covered under this policy.
[AGENT][NEUTRAL] And then for 99213 01 moment sorry gonna reset on me.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, that one is also not covered as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK, just want to confirm, uh, could you please help me with the receipt date and process date of the claim?
[AGENT][NEUTRAL] Sure, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so this claim was received [PII].
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] OK, just want to confirm and claim was denied, uh, denied as office visits are non-covered, uh, with the member plan, right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And the members plan type is secondary medical plan supplemental.
[AGENT][NEUTRAL] Yes. Yes, sir.
[CUSTOMER][NEGATIVE] And it, and it does not cover copay, coinsurance and deductible.
[AGENT][NEUTRAL] Uh, it is designed to help with that. Um, however, again it's not covered under this policy.
[CUSTOMER][NEUTRAL] OK, uh, can you please fax me the UB of my fax number?
[AGENT][POSITIVE] Absolutely, could you give me that fax number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] you can put my name as [PII] on the OB.
[AGENT][NEUTRAL] OK, I'm gonna read that back just to make sure I heard that correctly. That was [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alrighty I will get that sent to you [PII]. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Yes, can you please help me with the call, uh, claim number?
[AGENT][NEUTRAL] Oh, yes, that is 3,542,920.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK, 3,542,920 and the caller reference number will be your name and today's date, right?
[AGENT][NEUTRAL] First name last initial, and today's date, yes sir.
[CUSTOMER][POSITIVE] Great. Thank you, [PII]. That's fine today. Have a good day. Stay safe.
[AGENT][POSITIVE] You're very welcome. All right, thank you bye bye.
[CUSTOMER][NEUTRAL] Bye.