AccountId: 011433970860
ContactId: d0a617c8-87d7-4380-8209-6c8730acedba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 366790 ms
Total Talk Time (AGENT): 95673 ms
Total Talk Time (CUSTOMER): 68343 ms
Interruptions: 0
Overall Sentiment: AGENT=2.3, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/d0a617c8-87d7-4380-8209-6c8730acedba_20250422T16:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi [PII], I was trying to get claim status information for a member.
[AGENT][NEUTRAL] OK, I can help you with claim status. Can I please get your name and your call back number?
[CUSTOMER][NEUTRAL] Uh-huh. [PII] and direct line [PII].
[AGENT][NEUTRAL] Oh, thank you, Ms. [PII]. And what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Um, name is [PII]. Date of birth [PII], and I have 254-3925.
[AGENT][NEUTRAL] OK, let me pull up the policy real quick.
[AGENT][NEUTRAL] OK and then can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Data service is [PII] for $390 even.
[AGENT][NEUTRAL] OK, and then what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] Give me just a second here.
[AGENT][POSITIVE] Yes ma'am, take your time.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 37,440.
[AGENT][NEUTRAL] OK and then can you please give me the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yes, this is SSM Health Medical Group.
[AGENT][POSITIVE] OK, thank you so much, Ms. [PII]. um, can I put you on a quick hold while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much for holding for me Ms. [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I've got the claim pulled up for you. The claim number is 352.
[AGENT][NEUTRAL] 9058.
[AGENT][NEUTRAL] And the claim was denied for two reasons. One is office visits are not covered under the patient's policy.
[AGENT][NEUTRAL] And the other one is that vaccines are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] and vaccines.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so, uh, was the uh remaining balance put towards the patient responsibility?
[AGENT][NEUTRAL] We don't do patient responsibility we leave that up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But it was denied due to office visits and vaccine vaccines are not covered under the plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] It's 12.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK, is there a reference for this call?
[AGENT][NEUTRAL] Yes ma'am, you can use my name. It's [PII]
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][POSITIVE] OK. Thank you, [PII].
[AGENT][POSITIVE] You're very welcome, [PII]. Thank you for calling APL. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK well you have a good rest of your week. Thank you so much for calling APL bye bye.