AccountId: 011433970860
ContactId: ab5a7039-a204-486a-bf3e-9626c3ce082f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 224899 ms
Total Talk Time (AGENT): 99697 ms
Total Talk Time (CUSTOMER): 91362 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/ab5a7039-a204-486a-bf3e-9626c3ce082f_20250509T17:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], good morning. My name is [PII]. It's [PII] and the last [PII] is [PII]. Actually, I'm calling from the provider office from Piedmont Newton Hospital. And [PII], what's your last initial?
[AGENT][NEUTRAL] It's A
[AGENT][NEUTRAL] And I'm sorry, you said your name was spelled is that [PII]?
[CUSTOMER][POSITIVE] Perfect. And actually, I'm
[CUSTOMER][NEUTRAL] Yes, you're right, it's [PII] and the last last initial is [PII]. And actually I'm looking for a claim status patient. Will you be able to assist me with claim status today?
[AGENT][NEUTRAL] Got it.
[AGENT][POSITIVE] Absolutely I can check on a claim for you for sure. uh [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Got it. Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] I do have the policy number.
[CUSTOMER][NEUTRAL] Whenever you are ready,
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's 02581185.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The amount $1690 even.
[AGENT][NEUTRAL] OK, that was
[CUSTOMER][NEUTRAL] And I do have the EOB.
[AGENT][NEUTRAL] 00, you have the claim number?
[CUSTOMER][NEUTRAL] Yeah, please go ahead.
[CUSTOMER][NEUTRAL] Yeah, I do have the claim number.
[AGENT][NEUTRAL] OK, I'll go ahead and take that please.
[CUSTOMER][NEUTRAL] OK, it's 358-816-1.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEUTRAL] OK, so for this claim, Roger, we were unable to pay that benefit as the type of diagnostic test is not a covered test under this policy. So this is a limited indemnity medical plan and it only covers specific diagnostic tests like MRI, CAT scan, uh, CT, PET scan. So this simply was not covered under their policy.
[CUSTOMER][NEUTRAL] OK. I just want to ask that. Is that the patient active on data service or not?
[AGENT][NEUTRAL] Uh, let me see, hang on.
[AGENT][NEUTRAL] Yes, uh, so this policy's effective date was [PII] and it is currently active.
[CUSTOMER][NEUTRAL] OK. And you are saying it is non-covered, right? The policies are non-covered, right?
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And is that, uh, is that noncovered under the patient policy or it is under the provider's end?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Under the patient's policy, it's not covered.
[CUSTOMER][NEUTRAL] So can we build this patient?
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK, but you're saying it is patient responsibility, right?
[AGENT][NEUTRAL] We were unable to pay a benefit but we do not say what is patient responsibility that is up to the provider.
[CUSTOMER][POSITIVE] OK, I got my answer. You can provide me the reference number and thank you so much for the information, [PII].
[AGENT][NEUTRAL] Sure, that would just
[AGENT][NEUTRAL] Absolutely, a reference number would just be my first name, last initial, and today's date, and there wasn't anything else I can help you with?
[CUSTOMER][NEUTRAL] Can you please spell your name?
[AGENT][NEUTRAL] Oh, sure, that's uh.
[CUSTOMER][NEUTRAL] Uh, can you please spell your name for me?
[AGENT][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][POSITIVE] OK, I got it. Thank you so much and have a wonderful day and happy weekend as well. Bye for now.
[AGENT][POSITIVE] Of course, thanks for giving us a call. You too. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.