AccountId: 011433970860
ContactId: d8669b9b-920b-4200-9502-94e6740542b9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 396010 ms
Total Talk Time (AGENT): 144176 ms
Total Talk Time (CUSTOMER): 130263 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/d8669b9b-920b-4200-9502-94e6740542b9_20250415T13:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh hi, this is [PII]. That is [PII], and I'm calling from provider's office to check on claims.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with claim status. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Oh yeah, that is [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Uh, yeah, but before we proceed, I would like to inform you that this call is being recorded for training and quality purpose. Uh, so, are you OK with it?
[AGENT][NEUTRAL] Yes, that's fine.
[CUSTOMER][NEUTRAL] Uh, can you spell your name also, please?
[AGENT][NEUTRAL] It's [PII], um, it's spelled [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much. Uh, and the policy number is 023.
[AGENT][POSITIVE] Mhm, no problem.
[CUSTOMER][NEUTRAL] 48053
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] That is [PII], [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] [PII] $106 even.
[AGENT][NEUTRAL] OK, one moment, I'm waiting on my system.
[AGENT][NEUTRAL] OK. Yes, ma'am. We received this claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this claim denied because according to the diagnosis code, um, it was not related to an illness or an injury. And under this policy, services um that are related to an illness or an injury um is only covered. And I'm showing that this was for screening.
[CUSTOMER][NEUTRAL] Uh, just a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, infections of sexual mode of transmission?
[CUSTOMER][NEUTRAL] So the diagnosis is not covered as per member plan or something?
[AGENT][NEUTRAL] Yes, per member's plan.
[CUSTOMER][NEUTRAL] Uh, may I know the plan name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. Uh, may I have the claim number?
[AGENT][NEUTRAL] Yes, the claim number is 357-8216.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right, and I do have one more claim, just a moment.
[AGENT][NEUTRAL] Is it for the same member?
[CUSTOMER][NEUTRAL] Uh, no, uh, different number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, that is 0220.
[CUSTOMER][NEUTRAL] 39877
[AGENT][NEUTRAL] And thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] D of service, this is [PII]. Charge amount is $689 even.
[AGENT][NEUTRAL] You said that was for [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm not showing a claim on file, not with that date of service and those bill charges.
[CUSTOMER][NEUTRAL] Is active for the rate of service?
[AGENT][NEUTRAL] And just let me advise you that verification of coverage does not guarantee payment of claims. Um, I'm showing the effective date on this policy was [PII] and the policy is still active. So yes, the member was active on the date of service.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Just a moment. Let me confirm the address where we have well the claim.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, that is [PII]. Is it correct?
[AGENT][NEGATIVE] No, ma'am. That's not correct.
[CUSTOMER][NEUTRAL] OK. May I have the address, please?
[AGENT][NEUTRAL] Um, yes, the address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm. And that's in [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. And the zip.
[CUSTOMER][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. And the payer ID?
[AGENT][NEUTRAL] The peer ID is 60801.
[CUSTOMER][POSITIVE] OK, OK, thank you so much. Can I have call reference number?
[AGENT][NEUTRAL] Yes, so the reference number, you can use my name and today's date. My name is [PII], um spelled [PII] Last initial [PII] like [PII] and today's date. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Nothing. Thank you so much. Have a great day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling ATL. Mm bye.
[CUSTOMER][NEUTRAL] Bye bye.