AccountId: 011433970860
ContactId: a3e0049a-b4fd-40e3-baa1-4d144c80e99f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 451869 ms
Total Talk Time (AGENT): 110036 ms
Total Talk Time (CUSTOMER): 82281 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/26/a3e0049a-b4fd-40e3-baa1-4d144c80e99f_20250626T15:20_UTC.wav
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[AGENT][NEUTRAL] You for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] My name is [PII]. I'm checking our claim.
[AGENT][NEUTRAL] OK, [PII], happy to check on a claim. What's the policy number?
[CUSTOMER][NEUTRAL] 01669735
[AGENT][NEUTRAL] Do you have a good callback number?
[CUSTOMER][NEUTRAL] 6303200874.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII], sorry, business name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] What was the name again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the policy number is 01665735.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] I 01669735, right?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] In the billed amount?
[CUSTOMER][NEUTRAL] $309 even.
[AGENT][NEUTRAL] Not showing any claims on file for that date of service.
[CUSTOMER][NEUTRAL] Only one.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] So you found the claim?
[AGENT][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What was the build amount again, please?
[CUSTOMER][NEUTRAL] 309 even.
[AGENT][NEUTRAL] $309 even.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you by chance have any different amount after primary paid?
[CUSTOMER][NEUTRAL] OK, so then we left only $35.
[AGENT][NEUTRAL] They left $35.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] The only thing I have on file close to that is a claim for a billed amount of $40.59. I don't have anything for $309 or 35.
[CUSTOMER][NEUTRAL] Can you take any rejection?
[AGENT][NEUTRAL] I don't see any rejections. Do you have a claim number?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah, I have the claim number is 358-0957.
[AGENT][NEUTRAL] Let me pull that up. One moment.
[AGENT][NEUTRAL] OK, so that claim is received on [PII], processed [PII]. The claim was denied because office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] OK, so can we go to the patient.
[AGENT][NEUTRAL] We're not able to advise on patient responsibility that would be up to the facility or the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And even the BCBS, uh, sorry, yes, BCBS is primary process this claim.
[CUSTOMER][NEUTRAL] So you follow different guidelines, right?
[AGENT][NEUTRAL] Yeah, yeah, this plan does not cover the office visit fee.
[CUSTOMER][NEUTRAL] OK, what's the corrected claim filing limit?
[AGENT][NEUTRAL] There's no timely filing for a claim or corrected claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you send me the EOB through fax?
[AGENT][NEUTRAL] What's a good fax number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Should we mark attention to anybody on it?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII].
[AGENT][NEUTRAL] OK, give it about 5 minutes, [PII]. Is there anything else I can check on?
[CUSTOMER][NEUTRAL] No, that's all. What's the call office number?
[AGENT][NEUTRAL] Call reference is my name with today's date. My name again is [PII], that's [PII], last initial [PII], then today's date.
[CUSTOMER][POSITIVE] OK, thank you, thanks for that.
[AGENT][POSITIVE] You're welcome. Have a good day.