AccountId: 011433970860
ContactId: a8984970-7340-4e7c-8728-2f557e2add90
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 603739 ms
Total Talk Time (AGENT): 114736 ms
Total Talk Time (CUSTOMER): 60981 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=-1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/a8984970-7340-4e7c-8728-2f557e2add90_20250220T16:55_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, yes, I'm calling to check the status of a claim.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status. May I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And Miss [PII], may I have your call back number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and you're calling from which facility or provider, the name?
[CUSTOMER][NEUTRAL] ENT allergy and associates?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 01994047 ML 8.
[AGENT][NEUTRAL] That was 09114047.
[CUSTOMER][NEUTRAL] 0199.
[AGENT][NEUTRAL] 0199.
[AGENT][NEUTRAL] OK. One moment, let me pull that.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] [PII], uh, date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, the data service is 523-22, and then the uh charge is 225.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, let me see if I can find this. And for future, you can check claim status online through our website at [PII] and that's just optional. You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] That was [PII], correct?
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] Making sure I heard that year correctly.
[CUSTOMER][NEUTRAL] Yeah, you heard that right.
[AGENT][NEUTRAL] All right. OK. Let's see what happened.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Here it is. OK, so we received this claim on [PII]. Um, we processed [PII], and we denied the claim. And the reason for this denial is that office visits are not covered under the member's plan.
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] Do you happen to have access to an EOB you can send to me?
[AGENT][NEUTRAL] Yes, what is the fax number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 418.
[CUSTOMER][NEUTRAL] 9308.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, um, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][POSITIVE] No, no problem, thank you.
[AGENT][NEUTRAL] OK. Thank you. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. OK, Ms. [PII], I went ahead and send that over to you. It should be there in a few minutes. If you don't get it within 15 minutes, just give us a call back and we can resend it, but it should be there by then. Is there anything else I'm gonna help you with today?
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that's it. Thank you very much.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you.