AccountId: 011433970860
ContactId: c7b8dacf-3a0f-430f-8805-34a63f4c8890
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 569109 ms
Total Talk Time (AGENT): 107941 ms
Total Talk Time (CUSTOMER): 176967 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/c7b8dacf-3a0f-430f-8805-34a63f4c8890_20250107T15:17_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is. How may I help you?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII]. I'm calling with the provider's office. I want to know what the claim status.
[AGENT][NEUTRAL] OK [PII], I can help you with claim status. Can you please give me your callback number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Distributed.
[CUSTOMER][NEUTRAL] Uh, the patient name, first name is [PII], initial uh initials [PII] Last name [PII]
[AGENT][NEUTRAL] OK, and then what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And [PII]'s policy number please?
[CUSTOMER][NEUTRAL] It's um 01749398.
[AGENT][NEUTRAL] OK, let me pull in that policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what is the date of service, please?
[CUSTOMER][NEUTRAL] Um, sure, just a minute.
[CUSTOMER][NEUTRAL] baking.
[CUSTOMER][NEUTRAL] Please be on line. Give me one quick minute.
[AGENT][POSITIVE] Yes, please take your time.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh yes. So the date of birth, sorry, date of service is [PII]. The amount is $246 even.
[AGENT][NEUTRAL] OK and then what is the amount after primary paid their part?
[CUSTOMER][NEUTRAL] Uh, wait, it's $64.54.
[AGENT][NEUTRAL] Thank you and then what is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Um, just a minute.
[CUSTOMER][NEUTRAL] It's not in.
[CUSTOMER][NEUTRAL] Is Northern Eastern Health System.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold on while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK Miss [PII] this is I've got the claim pulled up for you. The claim number is 3,400,500.
[AGENT][NEUTRAL] And the claim was denied because the services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK. Uh, may I know the denied, denied date?
[AGENT][NEUTRAL] Yes, ma'am. Let me look
[CUSTOMER][NEUTRAL] And they received it also.
[AGENT][POSITIVE] Yes, let me look that up for you.
[CUSTOMER][NEUTRAL] You just
[AGENT][NEUTRAL] So the claim was reported on [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] [PII] or [PII]. OK, so you are saying that the coverage is terminated.
[AGENT][NEUTRAL] Right. Now, let me look to see if they have another, they do not have any active policies with us at this time.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] What
[CUSTOMER][POSITIVE] OK, that's right.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Uh, can you please, uh, repeat the proper denied statement for me once again?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh yes, let me look.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Maybe
[AGENT][NEUTRAL] These services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] This is after coverage terminated. OK. May I know the coverage range?
[AGENT][NEUTRAL] Uh, the effective date of the policy is [PII].
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] And the termination date is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It, oh, just a minute.
[CUSTOMER][NEUTRAL] It's uh [PII]. Yes.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, got it. 00, actually, we don't have this UB with us, so can you please check this UB to?
[AGENT][NEUTRAL] Yes, I'm gonna put you on a brief hold while I look up while I can I get your fax number real quick?
[CUSTOMER][NEUTRAL] The fax number uh yeah, the fax number is [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on hold while I send that fax to you. I'll be right back.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you again. The fax is on its way to you now.
[CUSTOMER][NEUTRAL] And right back
[CUSTOMER][POSITIVE] OK. uh, thank you so much, sorry.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] It