AccountId: 011433970860
ContactId: ae0cd214-78eb-4642-83e6-91f9c7f54554
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 412179 ms
Total Talk Time (AGENT): 107748 ms
Total Talk Time (CUSTOMER): 146033 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/ae0cd214-78eb-4642-83e6-91f9c7f54554_20250304T15:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Thank you for calling.
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII] and I'm calling from a provider's office. I need to verify the eligibility and also to see if a claim is on file for a patient.
[AGENT][NEUTRAL] OK, I can help you with the eligibility and also with the claim. [PII], can you please give me your callback number, sir?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. It's a direct number.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Thank you. And then what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Thank you and what's the.
[CUSTOMER][NEUTRAL] The patient's name is [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] And I have a policy number of 025.
[CUSTOMER][NEUTRAL] 60199.
[AGENT][NEUTRAL] Look up policy real quick.
[CUSTOMER][NEUTRAL] Look up.
[AGENT][NEUTRAL] OK, and you said it was for [PII] shoot?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm not showing that that policy number is 02560199 matches that member.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Policy number is 025604.
[CUSTOMER][NEUTRAL] Just that.
[CUSTOMER][NEUTRAL] OK. Give me one moment.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] I'm just trying to pull the card here. One moment.
[AGENT][POSITIVE] Yes sir, go ahead and take your time.
[CUSTOMER][NEUTRAL] Right, on the, yes, yes. On the patient card it's listed as [PII].
[CUSTOMER][NEUTRAL] 06199.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, I do show her now. I've got [PII] up and her policy is active, effective [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Oh it is active effective form of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And is, is American Public Life is a primary or secondary for the patient?
[AGENT][NEUTRAL] Or secondary.
[CUSTOMER][NEUTRAL] And who's the primary for the patient?
[AGENT][NEUTRAL] I don't have that information.
[CUSTOMER][NEUTRAL] I don't. Alright, got you, and I'm sorry, you said your name is?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] All right. And can you check if uh the, if I claim for a date of service of [PII]?
[CUSTOMER][NEUTRAL] Uh, for a total bill amount of $777.06 is on file.
[AGENT][NEUTRAL] I can check sir yes sir um can you also give me the charge amount after the paid their part?
[CUSTOMER][NEUTRAL] No, that's what we, the claim was submitted to American Public Life as primary.
[CUSTOMER][NEUTRAL] So that is what I just wanna make sure if the claim has been received and if it's any denial.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Hopefully should have been denied for missing primary AOB.
[AGENT][NEUTRAL] OK. Hmm.
[AGENT][NEUTRAL] Correct, uh, what is the name of the facility that you're calling from?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] This is for urgent care Group LLC.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up that claim and I'll be right.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][POSITIVE] Thank you, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 3502883.
[AGENT][NEUTRAL] OK [PII], I do have the claim up um the claim number is 3502838.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The clients
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] We received the claim on [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And processed it on [PII].
[CUSTOMER][NEUTRAL] On [PII]
[AGENT][NEUTRAL] And the claim was denied because we need the EOB from the primary insurance.
[CUSTOMER][NEUTRAL] Because we need to.
[CUSTOMER][POSITIVE] Got you. All right.
[CUSTOMER][NEUTRAL] And [PII], can I, can you help me with the call reference number?
[AGENT][NEUTRAL] Yes, sir. You can use my name and today's date.
[CUSTOMER][NEUTRAL] First initial of your last name?
[AGENT][NEUTRAL] A
[CUSTOMER][POSITIVE] All right. Thank you, [PII]. Thanks for your time. You have a wonderful day.
[AGENT][POSITIVE] You too, [PII]. You have a great day also and thanks for calling APL.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] Thank you though.
[AGENT][NEUTRAL] Bye-bye, sir.