AccountId: 011433970860
ContactId: a26834de-f8ac-4456-96da-46a0937e3a5c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 328420 ms
Total Talk Time (AGENT): 130307 ms
Total Talk Time (CUSTOMER): 128842 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/a26834de-f8ac-4456-96da-46a0937e3a5c_20250514T17:34_UTC.wav
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[AGENT][NEUTRAL] How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling from a medical provider's office. Can you hear me OK?
[AGENT][NEUTRAL] Yes,
[AGENT][NEUTRAL] It's just a little
[CUSTOMER][NEUTRAL] OK. I'm sorry, you're kinda muffled.
[AGENT][NEUTRAL] Yes, I'm sorry. I'm having trouble with my phone right now. Is there something that um that I can help with? Do you have a claim that I could look up or a policy number?
[CUSTOMER][NEUTRAL] Um, yes, it's actually an eligibility issue. I don't have a correct card to get her ID number, and I don't have her social. I don't know if you can help me or not.
[AGENT][NEUTRAL] Um, OK, we can look it up going by her name. Um, do you have the old card?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] I have nothing.
[AGENT][NEUTRAL] Oh, good. OK. So, uh, [PII], how do you spell the patient's last name, please?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Last name is [PII].
[AGENT][POSITIVE] Thank you. And the first name?
[CUSTOMER][NEUTRAL] Her first name is [PII]
[AGENT][NEUTRAL] Thank you. And her date of birth?
[CUSTOMER][NEUTRAL] Her date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you very much. While I'm looking this up, if I could just have a callback number please in the event that we're disconnected.
[CUSTOMER][NEUTRAL] Sure. My number is [PII].
[AGENT][POSITIVE] I appreciate that. Thank you. I'm just looking this up now.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so she has a policy that went into effect with us on [PII], and it is active, and [PII]'s policy number is 02.
[AGENT][NEUTRAL] 44.
[AGENT][NEUTRAL] 0225. So again, my phone is kind of messing up [PII] that went into effect on [PII] and is active. Now, is there anything else at all I can tell you about this, um, secondary or gap insurance?
[CUSTOMER][NEUTRAL] Um, no, um, I, well, we sent a medical claim for her, but we didn't have the proper ID number, so I don't know that you're able to find it and because I don't have her social, I can't find it on the portal.
[AGENT][NEUTRAL] What's um what was the date of service and and the build amount?
[CUSTOMER][NEUTRAL] Her date of service was 3-1725 dollars for $324.
[AGENT][NEUTRAL] OK, we did get your claim. Uh, that claim number is 359.
[AGENT][NEUTRAL] 6803 um but uh these policies don't cover anything that in a physician's office so they don't cover that office visit co-pay. What they do is they cover treatment within the.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] not
[AGENT][NEUTRAL] So, um, that
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We did get it
[AGENT][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK. Um, can you tell me when you received it?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] We, uh, received it on the [PII].
[AGENT][NEUTRAL] April and we processed it on the [PII]. Now I realized that this is the [PII].
[AGENT][NEUTRAL] take a
[AGENT][NEUTRAL] To, uh, to show up, so, um.
[AGENT][POSITIVE] Good
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um, if you don't mind, I'm gonna repeat this to you just because again, you are muffled. If you can hear me clearly, that's great.
[CUSTOMER][NEUTRAL] Um, her ID number is [PII].
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK. And the claim number is 359-6803.
[AGENT][NEGATIVE] Yes, and, and it was processed on the [PII]. It would have gone out to about that time and uh it's going to be a denial, unfortunately, because the policy doesn't cover.
[AGENT][NEUTRAL] that
[CUSTOMER][NEUTRAL] OK. OK. um, is there a chance you you could fax me a copy of that explanation of benefits?
[AGENT][POSITIVE] Absolutely, yes.
[AGENT][NEUTRAL] Um
[CUSTOMER][POSITIVE] Perfect. Thank you.
[AGENT][NEUTRAL] What is that
[CUSTOMER][NEUTRAL] My fax is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, is there anything else at all that I
[CUSTOMER][NEUTRAL] Um, nope, I think that's all I have. Um, if I could please ask you to repeat your first name for me, please?
[AGENT][NEUTRAL] Yes, my name is [PII].
[AGENT][NEUTRAL] The first letter of my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We'll be using that
[CUSTOMER][POSITIVE] Perfect. OK. Well, thank you so much for your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well thank you for contacting ATO.