AccountId: 011433970860
ContactId: ba708555-8576-46ef-b3cd-4b568bfefe3f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 366250 ms
Total Talk Time (AGENT): 116549 ms
Total Talk Time (CUSTOMER): 164186 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/ba708555-8576-46ef-b3cd-4b568bfefe3f_20250207T14:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm actually calling you from provider's office and checking on the claim status, [PII].
[AGENT][NEUTRAL] OK, can you spell your first name?
[CUSTOMER][NEUTRAL] Yeah, not a problem. First name is spelled as in [PII]. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Last name initial is [PII].
[AGENT][NEUTRAL] And how do you pronounce your name?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] In the, OK, and you said you're checking on a claim status?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] Yeah. The policy number of the patient is 1262468 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] 1262468 was there a number after the 8?
[CUSTOMER][NEUTRAL] Oh yeah. After the 8, it is M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] OK, what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. It is the right time, [PII].
[AGENT][POSITIVE] Thank you, thank you one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Verify the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] The patient first name which I have with you is [PII], and the last name is [PII]. Uh, do you mind, do you want me to spell the name for you?
[AGENT][NEUTRAL] No, uh [PII], is that [PII]?
[CUSTOMER][NEUTRAL] Yeah, [PII] is the first name.
[AGENT][NEUTRAL] What, what's your date of birth?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] OK, thank you for that. If you can just provide the date of service and the total charges.
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII] and the total charge amount is $459 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You can also check claim status online at [PII] as well.
[CUSTOMER][NEUTRAL] Actually, uh, I do have the portal access on this, but, uh, I'm not able to get a, sorry, get the status because, uh, the primary insured SSN number was not available in our system now, so.
[AGENT][NEUTRAL] You know, you can also search it by the patient's first name, their date of birth, and then the claim number which you would need to call us to get the claim number. So I do show that this claim was received [PII], processed on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it cites that.
[AGENT][NEUTRAL] The office
[CUSTOMER][NEUTRAL] Uh, is that February or January?
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] You said [PII] is the date of service?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so the date that we received the claim is.
[AGENT][NEUTRAL] [PII] of this year.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] And process it on [PII] of this year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, no, no payment was made on this claim. The office visit fee is not covered by the patient's policy.
[AGENT][NEUTRAL] And then the other two codes, it looks like the primary pay those charges in full. I'm showing a claim number of 356-0492.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And did you have any other questions I can assist with today?
[CUSTOMER][NEUTRAL] Uh, you said the claim number is 35605?
[AGENT][NEUTRAL] 040492.
[CUSTOMER][NEUTRAL] 92
[CUSTOMER][NEUTRAL] 0492. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 356-0492. 1 moment, please. Let me check that real quick in my system.
[CUSTOMER][NEUTRAL] Yeah, as you said, I'm not able to pull up this uh payment on the portal actually.
[AGENT][NEUTRAL] OK, are you on the portal?
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] OK and what what are you entering to search?
[CUSTOMER][NEUTRAL] Oh, I'm sorry. Actually, I got it in portal now. I'm so sorry. I think I have, uh, gone something wrong in the, in this one. Yeah, I do show that, uh, the claim in the portal. Yeah. Um, yeah, as you said, office visit was not covered under this special plan, but you said the claim was denied for?
[AGENT][NEUTRAL] Yeah, so once, once you populate the ELB, the explanation, the remarks that I'm reading is on that ELB on page 2.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm able to pull up DOB here one moment. Let me check that real quick.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh yes. It was listed as office visits are not covered by the above numbered policy or benefits are payable only if your major medical, something like, uh, is there much? Not a problem. Thank you so much. I got this one here and thank you so much for uh assisting me today. Yeah, as you said, this claim was processed on uh [PII]. Got it here.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] That is correct. Anything else, anything else?
[CUSTOMER][POSITIVE] Yeah, I got it. No, no, thank you so much for that information here. Thank you so much for asking me, [PII]. Is there any chance that you can provide me the difference for this call today?
[AGENT][NEUTRAL] My name in today's date [PII] last name is [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Got it, [PII]. Thank you so much for that information. And hope you have a great day ahead and happy Friday. Happy weekend. Thank you so much.
[AGENT][POSITIVE] You too, thanks for calling APL have a good day.
[CUSTOMER][NEUTRAL] You too bye.