AccountId: 011433970860
ContactId: d4464f10-7fd5-45e1-a6f5-b0e7921756fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 256320 ms
Total Talk Time (AGENT): 148062 ms
Total Talk Time (CUSTOMER): 56217 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/d4464f10-7fd5-45e1-a6f5-b0e7921756fc_20250529T17:54_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 calling on behalf of a provider about a claim that's been denied.
[AGENT][NEUTRAL] I can certainly look at the claim and who am I speaking, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII], thank you. What's that policy number we're looking at today?
[CUSTOMER][NEUTRAL] 1440654
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. Is there a callback number please, uh, in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yes, uh, [PII].
[AGENT][NEUTRAL] Sure, thank you. And um what is that uh that data service that you're looking for for one study.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the build amount
[CUSTOMER][NEUTRAL] $296.
[AGENT][NEUTRAL] OK, great. So um your.
[AGENT][NEUTRAL] As you know, your claim number is 3,599,550.
[AGENT][NEUTRAL] Now the uh claim itself was um.
[AGENT][NEUTRAL] It looks like that was received on the [PII]. We processed it on the [PII]. This policy has a deductible of its own. Now normally this is a secondary insurance and we pick up the deductible co-payment or co-insurance from the major medical.
[AGENT][NEUTRAL] But there's also a $500 deductible that must be met on this policy before we will pay out.
[AGENT][NEUTRAL] And um that was due on this uh and that the benefit for this uh was paid towards that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So that, that is where that benefit went was towards this policy is deductible.
[CUSTOMER][NEUTRAL] OK, so the only EOB that we've received is one saying that this is a duplicate.
[AGENT][NEUTRAL] OK, let me go ahead and fax this to you. What is your fax number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] 9630. Let me go ahead and send you this one. This will be the EOB that shows that this is uh um.
[AGENT][NEUTRAL] That the uh
[AGENT][NEUTRAL] Benefits went towards the deductible, um.
[AGENT][NEUTRAL] And uh let me go ahead and send that to you. It it uh you should receive it by uh today. Um, now, is there anything else that I need to do?
[AGENT][NEUTRAL] Uh, for you, is there anything else I can explain about the, about the explanation of benefits or anything?
[CUSTOMER][NEUTRAL] No, that was fine. Um, when you fax that, can you do attention [PII]?
[AGENT][NEUTRAL] Yes, yes, I certainly can, [PII]. I will go ahead and send that to you. You should be getting that just any time, uh, and I will have that information, and this is, uh, this is the only plan that we're looking at, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'll have that for you in just a moment. Um, my name is [PII], so the first letter of my last name is [PII]. We'll use that today's date as a reference, and, uh, that fax EOB, um, to, uh, [PII]. I should wait a minute.
[AGENT][NEUTRAL] OK, wait a minute. 758.
[AGENT][NEUTRAL] 59,630, is that?
[CUSTOMER][NEUTRAL] No, it's the fax number yeah 567.
[AGENT][NEUTRAL] Do you mind giving me the fax number again?
[CUSTOMER][NEUTRAL] 5,859,630
[AGENT][NEUTRAL] 9630. So [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Does that sound right?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] Yeah, my phone is cutting in and out. I just want to be sure that I've got it.
[CUSTOMER][POSITIVE] OK, yep, that was right.
[AGENT][POSITIVE] OK, OK, well thank you very much. I'll go ahead and send that to you. Um, thank you for contacting API. You have a good day.