AccountId: 011433970860
ContactId: ed8c383e-388c-44e7-84a0-012b720545a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 645020 ms
Total Talk Time (AGENT): 255211 ms
Total Talk Time (CUSTOMER): 204299 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/ed8c383e-388c-44e7-84a0-012b720545a7_20250617T19:22_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from provider office regarding the claim status.
[AGENT][NEUTRAL] I can help with the claim status. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, the policy number is?
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 343-220, M for Mike, L for Lima, 8.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please.
[CUSTOMER][NEUTRAL] Yeah, the patient's name is?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][POSITIVE] I appreciate that. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. Our callback number is [PII].
[AGENT][NEUTRAL] Thank you. What is the date of service for [PII], please?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, the rate of services.
[CUSTOMER][NEUTRAL] 01. It's [PII].
[AGENT][POSITIVE] I appreciate that. Is there a bill amount?
[CUSTOMER][NEUTRAL] Yeah, the bill amount is $658.
[AGENT][NEUTRAL] Thank you. Your claim number is 357.
[AGENT][NEUTRAL] 9661.
[AGENT][NEUTRAL] And that claim was received by us.
[AGENT][NEUTRAL] On the [PII] we processed it on the [PII].
[AGENT][NEUTRAL] Now, this policy, um,
[AGENT][NEUTRAL] Actually la
[AGENT][NEUTRAL] As of, um, let's see, [PII], so the date uh.
[AGENT][NEUTRAL] Let me check here.
[AGENT][NEUTRAL] So what we're looking for is the explanation of benefits from their primary insurance. The policy was active in January.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, but we, um, but [PII], what we need is the explanation of benefits from their primary insurance in order to finish processing.
[CUSTOMER][NEUTRAL] OK. Can you help me as per your coordination of benefits to the member have? Uh, can you tell me the member primary insurance?
[AGENT][NEUTRAL] Uh, let me just check.
[CUSTOMER][NEUTRAL] Yes, as per your reports, do you have
[AGENT][NEUTRAL] It looks like
[AGENT][NEUTRAL] It looks
[CUSTOMER][NEUTRAL] Member primary details.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like it's United Healthcare.
[CUSTOMER][NEUTRAL] OK. Can you help me with the uh policy number?
[AGENT][NEUTRAL] No, I'm sorry, I can't. That's the only information that I've got, but we do need that the explanation of benefits for that data service in order to finish processing the claim.
[CUSTOMER][NEUTRAL] OK, then. Thanks for that. Uh, can you help me with your complete name and initial and last name?
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII]. We're gonna use that today's date as a reference. Is there anything else I can help with?
[CUSTOMER][POSITIVE] Yeah, can we go with the one more member? I'm having 2 more members.
[AGENT][NEUTRAL] OK, and what's the next policy number, please?
[CUSTOMER][NEUTRAL] Yeah, sure. One moment, please.
[CUSTOMER][NEUTRAL] Yes. Um,
[CUSTOMER][NEUTRAL] The next policy number is?
[CUSTOMER][NEUTRAL] 233 26.
[AGENT][NEUTRAL] Um, 233-26.
[CUSTOMER][NEUTRAL] Yes, it's 233-26.
[AGENT][NEUTRAL] OK, um, is there any more to the policy number because that's
[AGENT][NEUTRAL] Uh, that's not really one of our.
[CUSTOMER][NEUTRAL] No, no, I'm having uh
[CUSTOMER][NEUTRAL] OK. Uh, can you check for this number? 240-46711300.
[AGENT][NEUTRAL] OK, that's not one of ours either, um, uh, [PII], I'm sorry, that neither one of those policy numbers are ours.
[CUSTOMER][NEUTRAL] OK. Can we able to go with the SSN number, Social Security number?
[AGENT][NEUTRAL] Yes, and what is that please?
[CUSTOMER][POSITIVE] Yeah. Thanks for that. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. [PII], excuse me, [PII]. Let me just check. And the insured's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah. It's [PII]
[CUSTOMER][NEUTRAL] 011 moment, please. One moment it was loaded once again.
[CUSTOMER][NEUTRAL] Let
[CUSTOMER][NEUTRAL] Yes, it's
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh, send the link. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. And what date of service are we looking for for her?
[CUSTOMER][NEUTRAL] Yeah. The date of service I'm looking for is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Is there a building amount?
[CUSTOMER][NEUTRAL] At [PII]. The bill amount is $200.
[AGENT][NEUTRAL] OK, your claim number is 359.
[AGENT][NEUTRAL] 4590.
[AGENT][NEUTRAL] Excuse me, just a moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. It looks like we received your claim, um.
[AGENT][NEUTRAL] We received your claim on the [PII] and we processed it.
[AGENT][NEUTRAL] On the [PII]. Now this uh policy, what we will need, we will, uh, the explanation of benefits from her major medical.
[AGENT][NEUTRAL] In order to finish processing, so that's uh 359-495-590, and we need the explanation of benefits from the major medical. Um, it looks like their, uh, major medical provider is also United Healthcare.
[AGENT][NEUTRAL] And so we would need that United Healthcare.
[CUSTOMER][NEUTRAL] Uh, sorry, uh,
[CUSTOMER][NEUTRAL] Yeah, got it. Sorry for the correction. Can you tell the claim number once again? It's 35.
[AGENT][NEUTRAL] It's 359.
[AGENT][NEUTRAL] 4590.
[AGENT][NEUTRAL] And that is the uh.
[CUSTOMER][NEUTRAL] It's 359-459.
[CUSTOMER][NEUTRAL] 0, that's it. OK, then. Got it.
[AGENT][POSITIVE] That's correct. Uh-huh.
[CUSTOMER][NEUTRAL] OK. Can we go with the another member ID?
[AGENT][NEUTRAL] And what is the last one?
[CUSTOMER][NEUTRAL] Yeah, one moment, please.
[CUSTOMER][NEUTRAL] Once again, I, I was just loading the patient. Yeah.
[CUSTOMER][NEUTRAL] So another member ID is [PII]. [PII].
[AGENT][NEUTRAL] Thank you. And the insured's name and date of birth, please?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you. And what is the date of services that we're looking for, Dagmire?
[CUSTOMER][NEUTRAL] The date of service is [PII] with the amount of $16.60 dollars.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] The claim number for this one.
[AGENT][NEUTRAL] It's 359.
[AGENT][NEUTRAL] 2830.
[AGENT][NEUTRAL] And it looks like we um.
[AGENT][NEUTRAL] Receive that
[AGENT][NEUTRAL] Let's check here.
[AGENT][POSITIVE] just a moment. She's got a lot of points.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] We received that on the [PII]. We processed it on the [PII]. This is going to be exactly the same thing, uh, we need that, uh, explanation of benefits from, uh, the primary insurance, uh, on, um, on that claim, and let me see who our uh major medical is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like her major medical provider.
[AGENT][NEUTRAL] Um, is, uh, United Healthcare. So, uh,
[CUSTOMER][NEUTRAL] OK. Can we, OK, can we go with one last member ID?
[AGENT][NEUTRAL] She would need it. Uh-huh.
[AGENT][POSITIVE] OK, I can do one more.
[CUSTOMER][NEUTRAL] Yeah, sure. One more last.
[CUSTOMER][NEUTRAL] Can I provide you the Prime member ID?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Yeah, sure. 01672883 M for Mary, L for Lima, 7.
[AGENT][NEUTRAL] Thank you. And the insured's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you and the date of service?
[CUSTOMER][NEUTRAL] Date of service [PII] with the bill amount of $15.50 dollars.
[AGENT][NEUTRAL] I'm checking.
[AGENT][NEUTRAL] OK, it looks like um your claim number on this one.
[AGENT][NEUTRAL] It's 359.
[AGENT][NEUTRAL] 6113.
[AGENT][NEUTRAL] And it looks like we received your claim.
[AGENT][NEUTRAL] On the [PII], we processed it on the [PII], but this policy was only in effect from [PII] until [PII].
[AGENT][NEUTRAL] So it was um it had lapsed by the time of that data served.
[CUSTOMER][NEUTRAL] OK, other than that the patient was not active for the date of service, am I correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Uh, so the claim coordinate. As for coordination of when, do you find that patient having any other issues?
[AGENT][NEUTRAL] Uh, no, I'm sorry, I don't.
[CUSTOMER][POSITIVE] OK, sure. Thank you so much. Have a wonderful day. Bye for now.
[AGENT][POSITIVE] OK, thanks for contacting API.