AccountId: 011433970860
ContactId: b7bfae5e-70be-4078-af0b-9260efd56b51
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274239 ms
Total Talk Time (AGENT): 120928 ms
Total Talk Time (CUSTOMER): 71179 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/b7bfae5e-70be-4078-af0b-9260efd56b51_20250508T19:52_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm I'm calling from provider's office to check on the claim status.
[AGENT][NEUTRAL] OK, so I can know the claim status. What is that policy number, please?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] I can help with a, with a claim status. What is the policy number, please, that I can, I can look up the policy.
[CUSTOMER][NEUTRAL] 021
[CUSTOMER][NEUTRAL] 688
[CUSTOMER][NEUTRAL] 15
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII]. Date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 291
[CUSTOMER][NEUTRAL] 40
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Direct line or extension.
[AGENT][POSITIVE] OK, thank you very much. What date of service were you looking for for [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] And is there a bill amount for this?
[CUSTOMER][NEUTRAL] $76,586.42.
[AGENT][POSITIVE] OK, thank you very much. I'm just looking for that now.
[AGENT][NEUTRAL] OK, it looks like you're
[AGENT][NEUTRAL] Claim number for this is 357.
[AGENT][NEUTRAL] 6302. So that's 3576302. It looks like we received your claim.
[AGENT][NEUTRAL] On the
[AGENT][NEUTRAL] [PII], we process it, process it on the [PII].
[AGENT][NEGATIVE] Now the policy does not have any benefits for this type of procedure.
[AGENT][NEGATIVE] So that for any type of surgery, um, it, it doesn't have any uh benefits. This is a hospital indemnity policy, but it just pays for very basic services.
[AGENT][NEGATIVE] And uh it's this is not one of the things that it will pay for.
[AGENT][NEUTRAL] So this is not covered by the patient's policy.
[CUSTOMER][NEUTRAL] Sorry, can
[CUSTOMER][NEUTRAL] So you're saying uh
[CUSTOMER][NEUTRAL] These benefits are not covered under member's plan.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, so we can build the patient for this one, I believe.
[AGENT][NEUTRAL] Well, I, I can't tell you that. Uh, the only thing I can tell you is that, is that, um, we have no contractual obligation to pay.
[AGENT][NEGATIVE] That's the only thing really that I can tell you is that we won't pay it.
[AGENT][NEUTRAL] I don't know whether they have any other, you know, policy.
[AGENT][NEUTRAL] So this is the only thing that we're looking for or?
[CUSTOMER][NEUTRAL] OK, I mean.
[CUSTOMER][NEUTRAL] OK. So can you confirm the uh
[CUSTOMER][NEUTRAL] Procedure codes which are not covered.
[AGENT][NEUTRAL] Well, it looks that what is listed on here uh is a surgery. OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And that it doesn't have a procedure code. It just says that it's a surgery, surgeries are not covered.
[AGENT][NEUTRAL] Under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, you mean the whole claim is denied for the same reason?
[AGENT][NEGATIVE] The, the entire claim is denied. That is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Mm thank you very much uh for this one.
[CUSTOMER][NEUTRAL] So, can you please provide me your name once again and the reference number for this?
[AGENT][NEUTRAL] Yes, my name is [PII]
[AGENT][NEUTRAL] We're going to use that and today's date, the [PII].
[AGENT][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] OK. Your name and today's date.
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][POSITIVE] OK. Thank you very much, uh, [PII], for the information and uh have a very good day.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for contacting me too.