AccountId: 011433970860
ContactId: 9b429e79-d96f-48af-a9e2-d41343d9e391
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 215250 ms
Total Talk Time (AGENT): 89423 ms
Total Talk Time (CUSTOMER): 50095 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/9b429e79-d96f-48af-a9e2-d41343d9e391_20250109T20:02_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I was just calling trying to get status on a claim, please.
[AGENT][NEUTRAL] OK, sure, I can assist you with claims Ms. [PII], um, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII], that is a private line.
[AGENT][NEUTRAL] OK, and may I have um patient's policy number?
[CUSTOMER][NEUTRAL] 022 03942
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lana, 7.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah OK.
[AGENT][NEUTRAL] OK, let me have the name and date of birth of the patient.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The service is [PII] for $382 with $60 billed secondary.
[AGENT][NEUTRAL] OK, let's see if I can find this claim, and for future you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] Yeah, let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright
[AGENT][NEUTRAL] OK, so it looks like we received the claim [PII], processed [PII], and it was denied stating that office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK, um, is the remaining balance is $60 is that patient responsibility?
[AGENT][NEUTRAL] And we don't have any contractual involvement on the remaining of the claim because we're just a secondary, so it will fall back to the primary. So if the primary applied it to the member's responsibility, that's what's gonna be.
[AGENT][NEGATIVE] Because it's not payable, boss.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Thank you and can I get a call reference number? That was all I was needing.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, we don't have reference numbers, Ms. [PII]. You can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] Uh, just the spelling of your name, please.
[AGENT][NEUTRAL] OK. Sure. That's [PII]. Last initial [PII].
[CUSTOMER][POSITIVE] Thank you so much for your help and have a good day.
[AGENT][POSITIVE] You're welcome. You as well, and thank you for calling ATL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.