AccountId: 011433970860
ContactId: f242626a-12dc-4ec0-8d82-8bc9f8169836
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 393559 ms
Total Talk Time (AGENT): 121506 ms
Total Talk Time (CUSTOMER): 152243 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/f242626a-12dc-4ec0-8d82-8bc9f8169836_20250609T15:41_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL.
[AGENT][NEUTRAL] How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling. Hi, this is [PII] calling for provider to check on additional information about the claim that has been denied. Please know this call will be monitored and recorded for quality and training purposes. How is it going?
[AGENT][POSITIVE] OK, it's going well. How's yours going?
[CUSTOMER][POSITIVE] Yes, it's going well. How do you spell your name for me, please?
[AGENT][POSITIVE] It's [PII] and then I can definitely get clarification regarding that claim for you. uh, [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yeah, sure. Your name is spelled as [PII], right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, thank you so much. And the callback number is [PII] and that's a direct line.
[AGENT][NEUTRAL] OK thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] The member ID I have here that is, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes. The member ID I have here that is uh 02189603.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Yes, the name of the member is uh
[CUSTOMER][NEUTRAL] That is [PII].
[CUSTOMER][NEUTRAL] The date of birth is on [PII].
[AGENT][NEUTRAL] OK perfect thank you for verifying that and then do you have that claim number?
[CUSTOMER][NEUTRAL] The, the claim number which I have here that is uh 3601401, claim number which I have here.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, and this was with is it uh Athens or orthopedic clinic?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] This was um
[CUSTOMER][NEUTRAL] So you're asking for the name of the facility, right?
[AGENT][NEUTRAL] What was it Athens orthopedic?
[CUSTOMER][NEUTRAL] Yes, the name of the facility is
[CUSTOMER][NEUTRAL] The name of the facility is Athens Orthopediatrics Clinic PE.
[AGENT][NEUTRAL] Got it thank you for that. OK, so for this claim it looks like um so this is a secondary medical policy and we would need a copy of the primary EOB so it does not look like we received that um so if you have that information you could send that to us and then we can continue processing this claim.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah, sure, just a moment. It doesn't need for a primary.
[CUSTOMER][NEUTRAL] You will be, right?
[AGENT][NEUTRAL] Right, we're just missing the primary EOB.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes, thank you so much. Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh may I know whether you need the
[CUSTOMER][NEUTRAL] Just a moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, sir, thank you so much. Whether you need the payment, you will be alone or you need uh, you needed the claim form.
[AGENT][NEUTRAL] No, no, uh, that's all that we're needing is the primary EOB.
[CUSTOMER][NEUTRAL] Yes, you need the payment, you will be alone, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you. May I know how can I send it to you?
[AGENT][NEUTRAL] Um, I've got a mailing address and a fax number I can give you.
[CUSTOMER][NEUTRAL] Yes, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's OK. Thank you. Uh, can you provide me the mailing mailing address?
[AGENT][NEUTRAL] Mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] OK, uh, zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So that is.
[CUSTOMER][NEUTRAL] That is [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Uh, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, OK. Thank you. And the mailing address is, uh, OK, you're giving me the mailing address. So may I know the fax number?
[AGENT][NEUTRAL] Fax number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII]. OK, thank you so much. Uh and uh
[CUSTOMER][NEUTRAL] Just a moment. And uh is there, is there any time limit for this, sir?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The time limit will be over 60 days from the just please for, please for for.
[AGENT][NEUTRAL] No, not from
[AGENT][NEGATIVE] No, there's no timely filing limit. There is no timely filing limit for missing information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh. OK, thank you. And uh will I able to get the call number for this claim, please?
[AGENT][NEUTRAL] Could you repeat that? I'm sorry.
[CUSTOMER][NEUTRAL] Yes, we are able to get the reference number for this claim, please?
[CUSTOMER][NEUTRAL] Call reference number.
[AGENT][NEUTRAL] Uh, reference number would just be my first name, last initial, and today's date. Uh, so my last initial is A. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's the one that is K E R E and uh your initial is C and today state, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Yes, so.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][POSITIVE] Yes, thank you so much, [PII]. You have made a great help for today. Have a great day. Bye.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] I