AccountId: 011433970860
ContactId: b21e58f6-2c5e-418c-ab6e-83911c437062
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 617059 ms
Total Talk Time (AGENT): 176676 ms
Total Talk Time (CUSTOMER): 128820 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/b21e58f6-2c5e-418c-ab6e-83911c437062_20250325T17:57_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, this is [PII] calling from office. How are you doing today?
[AGENT][POSITIVE] I'm good, [PII]. How are you doing?
[CUSTOMER][POSITIVE] I'm doing great. Thank you for asking. And I need some help with the claim.
[AGENT][POSITIVE] Good. Well, how can I help you?
[AGENT][NEUTRAL] OK. Are you needing a claim statal information on a claim?
[CUSTOMER][NEUTRAL] Uh, I'm sorry, I need some help with the thing.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what type of help do you need with a claim?
[CUSTOMER][NEUTRAL] Uh, general status?
[AGENT][NEUTRAL] OK. Yes, I can help you with claim status and [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and no extension?
[AGENT][NEUTRAL] Thank you, and the patient's policy number, please?
[CUSTOMER][NEUTRAL] Alright, give me one minute.
[CUSTOMER][NEUTRAL] Uh, it's 016.
[CUSTOMER][NEUTRAL] 439
[CUSTOMER][NEUTRAL] 78 M as in Mike, L as in Lima.
[CUSTOMER][NEUTRAL] Number 8
[AGENT][NEUTRAL] OK, thank you. Give me a couple of moments, [PII], to get the member's information pulled up please.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[CUSTOMER][NEUTRAL] Give me one moment. With the date of birth, uh [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of total bill amount for her place?
[CUSTOMER][NEUTRAL] Date of service, [PII].
[CUSTOMER][NEUTRAL] Oh, wait a minute.
[CUSTOMER][NEUTRAL] For a total bill amount of uh $10,231 even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[AGENT][NEGATIVE] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] 88
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 21.
[AGENT][NEUTRAL] And the reason for the denial on this claim, [PII]?
[AGENT][NEUTRAL] States the maximum payable for this date of service has been met.
[CUSTOMER][NEUTRAL] Maximum payable for this date of service, right?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But uh we haven't received any payment for this date of service. This is the only claim that we have billed and that it was a deductible from the primary.
[AGENT][POSITIVE] That is correct because it was, yes, sir, but it was processed on.
[AGENT][NEUTRAL] That is because other claims were processed prior to your claim being received and which benefits were paid.
[CUSTOMER][NEUTRAL] So, uh, is it a patient responsibility then?
[AGENT][NEUTRAL] We do not determine patient responsibility. That would be up to the provider. This is, we are not a major medical carrier. This is only a supplemental.
[AGENT][NEUTRAL] Policy
[CUSTOMER][NEUTRAL] OK. So, uh,
[CUSTOMER][NEUTRAL] Got it, understood. And uh is it possible for you to fax us a copy of your bill?
[AGENT][NEUTRAL] Is it possible that you can print it directly from our portal?
[CUSTOMER][NEUTRAL] Uh, no, I'm sorry, we do not have access for the portal.
[AGENT][NEUTRAL] So give me just one moment to get that pulled up. Do you have our portal?
[AGENT][NEUTRAL] Website.
[CUSTOMER][NEGATIVE] Uh, actually, you are cutting in and out. Uh, I do not, I'm not able to hear you at all.
[AGENT][NEGATIVE] I'm sorry, there's a bad connection.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, you were saying something?
[AGENT][NEUTRAL] Uh, let me pull up the explanation of benefit.
[AGENT][NEUTRAL] But you said that you cannot access our portal, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Still loading
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Does it need to be, excuse me, does the fax I mean need to be put to your attention, [PII]?
[CUSTOMER][NEUTRAL] Uh, no, I do have an, uh,
[CUSTOMER][NEUTRAL] Number
[CUSTOMER][NEUTRAL] As an attention here.
[AGENT][NEUTRAL] OK. What is that?
[CUSTOMER][NEUTRAL] It's 121
[CUSTOMER][NEUTRAL] 605-1.
[AGENT][NEUTRAL] OK, again, that's 121605-1. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is your fax number, please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and I'm gonna repeat that back. [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] OK. So I have faxed that to you. So you should be receiving that uh very soon. It has been sent.
[CUSTOMER][NEUTRAL] Got it. And uh
[CUSTOMER][NEUTRAL] Uh, can you please help me out with the payment details like, uh, the claim that was paid earlier?
[AGENT][NEUTRAL] No, sir, I can't. That's for a different provider? Yes, sir. No, I can't provide you information related to another provider's claim.
[CUSTOMER][NEUTRAL] Prior to our claim.
[CUSTOMER][NEUTRAL] Got it. And can you also please help me out with the uh your name again and the call reference number?
[AGENT][NEUTRAL] Again, my name is [PII], and my name and today's date will be your call reference number.
[CUSTOMER][NEUTRAL] And the first initial of your last name would be?
[AGENT][NEUTRAL] S
[AGENT][NEUTRAL] As in [PII].
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Got it. Thank you, it was nice talking to you, helped me a lot today.
[AGENT][NEUTRAL] What is your first initial to?
[AGENT][NEUTRAL] Your last name [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, you're welcome, but what is the first initial to name?
[AGENT][NEUTRAL] The same as mine.
[CUSTOMER][NEUTRAL] 72, yes.
[AGENT][NEUTRAL] OK. All right. Well, again, is there anything else I can help you with today, [PII]?
[CUSTOMER][POSITIVE] No, [PII]ng. You helped me about today. It was nice talking to you. Thank you.
[AGENT][POSITIVE] It was nice speaking to you as well, and thank you again for calling APL. I hope you have a nice rest of your day.
[CUSTOMER][POSITIVE] You too. Thank you.