AccountId: 011433970860
ContactId: 9f2aba6a-cdd8-4afe-8cfe-253533c09c29
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 376910 ms
Total Talk Time (AGENT): 127578 ms
Total Talk Time (CUSTOMER): 126261 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/9f2aba6a-cdd8-4afe-8cfe-253533c09c29_20250304T17:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from a provider office I'd like to check the claim status.
[AGENT][NEUTRAL] Sure, I can check on a claim for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] My first name is uh [PII]. It's [PII], and last name, [PII].
[AGENT][NEUTRAL] OK, thank you. No, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] is a direct line.
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's uh
[CUSTOMER][NEUTRAL] 1360083
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the insured please?
[CUSTOMER][NEUTRAL] And first name is uh [PII], last name is uh [PII], and the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Uh [PII] and the total amount is $449.79.
[AGENT][NEUTRAL] OK, that was $449.79?
[CUSTOMER][POSITIVE] Yeah, correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so I will let you know that this policy terminated [PII].
[AGENT][NEUTRAL] And I did check to see this is the only policy that they have with us um but I could still see if we received that claim.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, one moment please.
[AGENT][NEUTRAL] What was the name of the provider's office this was through Rio?
[CUSTOMER][NEUTRAL] Uh, yeah, uh, calling from uh Advantage Family Care Incorporation.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Wait just a moment.
[AGENT][NEUTRAL] OK, so we did receive this claim and of course we were unable to pay a benefit as the services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] OK. So no claim was received, right?
[AGENT][NEGATIVE] No, we did receive the claim. We were just unable to pay a benefit as the services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] Uh, OK. The, actually the claim or is received, but the, the coverage was termed, right?
[AGENT][NEUTRAL] Correct, the policy terminated uh [PII].
[CUSTOMER][NEUTRAL] OK. Can I have the claim received date, please?
[AGENT][NEUTRAL] Yes, this claim was received [PII], and it was processed on [PII].
[CUSTOMER][NEUTRAL] Like uh
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. And uh
[CUSTOMER][NEUTRAL] And coverage was not processed due to coverage term on [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] One second I'll note it down.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is the patient has any other IT coverage?
[AGENT][NEGATIVE] No, not with us.
[CUSTOMER][NEUTRAL] OK. And can I have the claim number for this, please?
[AGENT][NEUTRAL] Yes, that is 352-727-0.
[CUSTOMER][NEUTRAL] Can you please fax me the UB copy of this to a fax number?
[AGENT][NEUTRAL] Of course, what was that fax number for you?
[CUSTOMER][NEUTRAL] Uh, yeah, one second, uh.
[CUSTOMER][NEUTRAL] The fax number is 201.
[CUSTOMER][NEUTRAL] 627
[CUSTOMER][NEUTRAL] 3671.
[AGENT][NEUTRAL] OK, I'm going to read that back to you to make sure I heard that correctly. That was 201627-3671?
[CUSTOMER][POSITIVE] Uh yes, correct.
[AGENT][NEUTRAL] OK, alright, I will get that sent to you. I should get it here in maybe 10-15 minutes. Was there anything else I could help you through?
[CUSTOMER][NEUTRAL] Uh yeah, one moment. I'll note it down.
[CUSTOMER][NEUTRAL] Just you and the UB attention is uh T as in Tango, N as in Nancy, 011.
[AGENT][NEUTRAL] Could you repeat that? I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, the tension is T as in Tango, N as in Nancy, 011.
[AGENT][NEUTRAL] 011. OK, got it.
[CUSTOMER][NEUTRAL] Can I have your name, please?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] [PII] and your last name, [PII], please?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. And patient also not having any other coverage, right?
[AGENT][NEGATIVE] Not with us.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] More active knowledge.
[CUSTOMER][NEUTRAL] Can I have the call reference for this, please?
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date. Was there anything else I could help you with for you?
[CUSTOMER][POSITIVE] Oh, I didn't know that. I got enough information and uh thank you so much for the patient response. Have a great day OK.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] are under
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, one second. In this case, you have to contact the patient for uh uh for active coverage information, right?
[AGENT][NEUTRAL] Right, as far as what we have, uh, we don't show that they have any other coverage, at least not with us.
[CUSTOMER][POSITIVE] OK. Yeah. Thank you. Thank you so much for the information and the questions. Yeah, bye-bye.
[AGENT][POSITIVE] All right. Thank you. Of course. Have a great rest of your day. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah, bye bye.