AccountId: 011433970860
ContactId: 953f9a81-1ddc-4be3-a2a2-49f0cc1809f7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 286670 ms
Total Talk Time (AGENT): 83777 ms
Total Talk Time (CUSTOMER): 177852 ms
Interruptions: 5
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/953f9a81-1ddc-4be3-a2a2-49f0cc1809f7_20250408T18:13_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII]. I'm calling from provider office to check on claims. Could you please help me out?
[AGENT][POSITIVE] All right. I'm happy to check on a claim status for you today. Uh, can I get the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, the member ID will be 02166569.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And if I can get [PII] the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Uh, the patient's name is [PII] [PII] [PII], [PII]. And the last initial of the first name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth will be [PII].
[AGENT][POSITIVE] Thank you. Data service?
[CUSTOMER][NEUTRAL] The date of service will be [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] No claims on file for that date of service.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Um, could you please provide me the card, uh, sorry, could you please provide me the mailing address?
[AGENT][NEUTRAL] Claims mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. May I know the timely filing limit?
[AGENT][NEGATIVE] No timely filing limit.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And just a minute.
[CUSTOMER][NEUTRAL] [PII] and [PII]. No time. Could you please spell out your name for my documentation?
[AGENT][NEUTRAL] My name is spelled [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] My last initial is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. And could you please provide me the uh call oh sorry, before that, I have a one more claim. It means uh same date of service. Could you please uh same number with different date of service.
[AGENT][NEUTRAL] Yeah, what's the data service.
[CUSTOMER][NEUTRAL] Uh, the date of service will be [PII] and the bill amount is $205 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we did receive this claim on [PII].
[AGENT][NEUTRAL] The claim was denied on [PII]. Office visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, so who's responsible for the payment?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's patient responsibility, right?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility. That's up to the facility or the provider.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] It's not uh.
[CUSTOMER][NEUTRAL] OK. This is the right of for patient, uh, we don't know, right?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, what was that question again, [PII]?
[CUSTOMER][NEUTRAL] Uh, the services, I mean, out, out of visit services are not covered, right? But, uh, who's responsible for the payment?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Correct, office visits are not covered under the member's plan.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Uh, could you please provide me the call call reference number?
[AGENT][NEUTRAL] Call reference is my name with my last initial than today's date.
[CUSTOMER][POSITIVE] Yes, thank you for your assistance. Have a nice day. Bye-bye.
[AGENT][NEUTRAL] You too. Bye.