AccountId: 011433970860
ContactId: bbbaa325-91fe-460f-8f97-574aa103a4db
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 431320 ms
Total Talk Time (AGENT): 179334 ms
Total Talk Time (CUSTOMER): 131533 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/bbbaa325-91fe-460f-8f97-574aa103a4db_20250103T13:51_UTC.wav
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[AGENT][NEUTRAL] Contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh, hi, ma'am.
[CUSTOMER][POSITIVE] Good morning.
[AGENT][POSITIVE] Good morning. How may I help you?
[CUSTOMER][NEUTRAL] But I just want to know the claim status, ma'am.
[AGENT][NEUTRAL] I can help with claim status. With whom am I speaking, please?
[CUSTOMER][NEUTRAL] Uh, my name is [PII], ma'am. [PII]. And could you please repeat your name?
[AGENT][NEUTRAL] My name is uh [PII]. What is that policy number that we're looking at today?
[CUSTOMER][NEUTRAL] OK, [PII]. Uh, it's for American Public Life Insurance and the policy number is
[CUSTOMER][NEUTRAL] Just give me a second.
[CUSTOMER][NEUTRAL] Let me pull up the details. Yeah. It's 1066765.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] OK. So the first name is [PII].
[AGENT][NEUTRAL] Thank you. And the date of birth?
[CUSTOMER][NEUTRAL] OK, it's for [PII].
[AGENT][NEUTRAL] OK. I, I meant, I meant the, the patient's date of birth.
[CUSTOMER][NEUTRAL] Yeah, I'll just provide you the patient date of birth.
[AGENT][NEUTRAL] Oh, that's, that's it, it's [PII]. OK, I see. OK, let me see what I can find here.
[CUSTOMER][NEUTRAL] It's for
[CUSTOMER][NEUTRAL] No, it's, ma'am, it's
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Perfect, thank you. Let me just see. And I just need a callback number please in the event that we're disconnected.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. What, what is the data service that we're looking for, please?
[CUSTOMER][NEUTRAL] OK, so the
[CUSTOMER][NEUTRAL] D of services, it's for, ma'am.
[CUSTOMER][NEUTRAL] Uh, [PII]. Actually, the, it's for a secondary one.
[CUSTOMER][NEUTRAL] Not a primary claim, it's a secondary claim.
[AGENT][NEUTRAL] Right, right. Yes, this is a secondary insurance. Um, so we're looking for [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. OK, let me see what I can find here.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So, I don't have anything for [PII]. Excuse me, excuse me, [PII]. Let me just check this one more time just to be absolutely certain. Uh, OK, here we go.
[CUSTOMER][NEUTRAL] Oh, OK, yeah.
[AGENT][NEUTRAL] OK, let's try this. OK. OK. And what is your um your uh billed amount, please?
[CUSTOMER][NEUTRAL] So the primary bill amount is 146 and the crossover amount is $62.50.
[AGENT][NEUTRAL] OK. All right. Let me just see what we have here.
[AGENT][NEUTRAL] And thank you for holding with me. I'm just checking this. OK, so this was for uh CPT code 99213-25.
[AGENT][NEUTRAL] In the amount of $146.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And it looks like we received your claim.
[AGENT][NEUTRAL] On
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Um, just checking here, apologize.
[AGENT][POSITIVE] Oh goodness.
[AGENT][NEUTRAL] I write that down.
[AGENT][POSITIVE] Yeah, here we go.
[AGENT][NEUTRAL] OK, it looks like we received your claim on [PII], and we processed it on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]. Now, um, that CPT code is not covered by this secondary policy. And so what we did was we sent back a denial.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, could you please provide me the claim number, ma'am?
[AGENT][NEUTRAL] Yes, it's 352.
[AGENT][NEUTRAL] 662 1.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 352
[CUSTOMER][NEUTRAL] 662-1.
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK. Can we go with the next number, ma'am?
[AGENT][NEUTRAL] OK, and what is the next, um, it's another policy number or another date of service?
[CUSTOMER][NEUTRAL] Uh, just give me a second, let me check.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, it's for different, different member, ma'am.
[AGENT][NEUTRAL] OK, and what is that policy number, please?
[CUSTOMER][NEUTRAL] Just give me a second. Let me provide you the policy number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, so the next policy number is
[CUSTOMER][NEUTRAL] 142052 8 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] OK. So the first name is [PII] and the last name is [PII] [PII].
[CUSTOMER][NEUTRAL] And the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the data service that we're looking for, [PII]?
[CUSTOMER][NEUTRAL] OK. It's for
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 2024.
[AGENT][NEUTRAL] And is there a particular bill amount, please?
[CUSTOMER][NEUTRAL] Yeah, it's for $146 ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, your claim number on this one.
[AGENT][NEUTRAL] Is 352.
[AGENT][NEUTRAL] 073 0
[AGENT][NEUTRAL] And it looks like we received your claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On [PII], and we processed it on [PII].
[AGENT][NEGATIVE] Now, that uh particular CPT code, uh, again, is not um uh covered under this uh policy. So we were unable to pay that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] So that was a denial.
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] OK, ma'am. And uh could you please provide me the call reference number?
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII], and we're gonna use that in today's date as our reference. Is there anything else at all that I may help with?
[CUSTOMER][NEUTRAL] Could you please spell out your name?
[AGENT][NEUTRAL] Yes, of course. It's [PII]
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][POSITIVE] Thank you, [PII]. Have a, take care. Bye-bye. Oh.
[AGENT][POSITIVE] OK, thank you for contacting you too have a good day.