AccountId: 011433970860
ContactId: b21e775d-8e84-43be-b463-38d4f8730d5f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323720 ms
Total Talk Time (AGENT): 109384 ms
Total Talk Time (CUSTOMER): 157220 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/b21e775d-8e84-43be-b463-38d4f8730d5f_20250328T16:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, good day, this is [PII], um, calling from MUSC physicians. What did you say your name was?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Hey [PII], I'm calling. I, I normally speak with.
[CUSTOMER][NEUTRAL] Uh, I can't remember her name, but I, she taught me, she's the one that showed me how to, um,
[CUSTOMER][NEUTRAL] Upload, uh, file the claim on the portal.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, so I'm calling to check on the status.
[CUSTOMER][NEUTRAL] Of a claim that I uploaded uh back [PII].
[CUSTOMER][NEUTRAL] And I just wanna see the status of it maybe it has a claim number by now or you know something like that, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, OK, I can check on that claim for you. Um, first, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes ma'am. Oh yes, [PII], and that's direct.
[AGENT][NEUTRAL] OK, thank you. And then, uh, did you have that policy number?
[CUSTOMER][NEUTRAL] Yes it is.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 2446538
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh
[CUSTOMER][NEUTRAL] You OK, you're welcome. [PII] 112879.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Perfect, thank you for verifying that. OK, and you said you uploaded this, uh, [PII], um, could you give me the date of service for the claim?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes, [PII] for $277.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 277. OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we did receive that claim at Lahan we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK, uh, $0 no office visit.
[CUSTOMER][NEUTRAL] And can I have that claim number?
[AGENT][NEUTRAL] Absolutely. That is 356-9204.
[AGENT][NEUTRAL] And I can send you a copy of the EOB if you need that. Oh sorry, go ahead.
[CUSTOMER][NEUTRAL] 35
[CUSTOMER][NEUTRAL] I'm sorry too Kara um 356-9204.
[AGENT][NEUTRAL] No, it's OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, and you received it when I did it, [PII]. Good job, and it was processed when?
[AGENT][NEUTRAL] Uh, [PII], it was the [PII].
[CUSTOMER][NEUTRAL] The same day.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, alright, and let me see, can you check on [PII]'s? I have a, uh, another member that I, um, did hers the same day. Would you check on her for me?
[AGENT][NEUTRAL] Sure, this was for a different policy.
[CUSTOMER][NEUTRAL] Yes, uh huh, different policy number.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, yeah, I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] And it's probably gonna OK it is 02265945.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was this number's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII] [PII].
[CUSTOMER][NEUTRAL] Um, data service is 813-2024 for $277. It may have that same denial.
[AGENT][NEUTRAL] Maybe we can take a look though just to make sure.
[CUSTOMER][NEUTRAL] Office visit
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yes, um, well, actually that one's showing up at a duplicate. Sorry, one moment, let me find the original.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And yeah, you probably would have seen an original because if we didn't if I didn't see it on the portal I probably would have resubmitted it.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] There we are, OK, so I did find that original claim number, um, so yes, that denial reason is the same office visits are not covered.
[CUSTOMER][NEUTRAL] OK, and may I have that claim number?
[AGENT][NEUTRAL] Yes, uh, so the original that was 3,542,760.
[CUSTOMER][NEUTRAL] 60 OK.
[CUSTOMER][POSITIVE] Thank you, thank you so much [PII]. May I have a reference number for the call?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yes, that would just be my first name, last initial, and today's date. Uh, so my last initial is [PII] Was there anything else I could help you with this [PII]?
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][POSITIVE] No ma'am thank you have a great weekend.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye bye.