AccountId: 011433970860
ContactId: f98db195-ec1c-4329-b2b1-000d7bf8d5f2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 710440 ms
Total Talk Time (AGENT): 199651 ms
Total Talk Time (CUSTOMER): 165928 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/f98db195-ec1c-4329-b2b1-000d7bf8d5f2_20250528T17:28_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] from provider's office checking on the same status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII], and may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure. That is [PII]. And the policy number is D as in Delta 43509203.
[AGENT][NEUTRAL] Thank you for that. And do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] Um, yes.
[AGENT][NEUTRAL] And on the ID card, do you see anywhere that says in hospital or outpatient policy cert number?
[CUSTOMER][NEUTRAL] Just give me one.
[CUSTOMER][NEUTRAL] Sorry, I don't have that information.
[AGENT][NEUTRAL] OK, I can also search with the member's first and last name or their full social if you have it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK. I have the Social Security number. That is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And the member's first and last name?
[CUSTOMER][NEUTRAL] That's it.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] I think
[AGENT][NEUTRAL] And you said this is her claim status correct?
[CUSTOMER][NEUTRAL] Um, yes.
[AGENT][NEUTRAL] And are you needing the medical or dental policy?
[CUSTOMER][NEUTRAL] Medical
[AGENT][NEUTRAL] OK, here it is. Hold on one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's date of birth?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So the policy number is 226-6763.
[AGENT][NEUTRAL] And may I have the date of service and the total bill for the claim?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Sure. It's [PII]. But the amount is $307 even.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold while I locate the claim?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] Oh, you are on hold.
[AGENT][NEUTRAL] 307 might be this.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for the wait. Um, so I have um located the claim. So we received the claim twice. Um, the first claim we received.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Sorry, I've just lost my spot. The first um claim we received was on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number 3502979.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied, um, code 336415.
[AGENT][NEUTRAL] was denied because any puncture is not covered on the policy?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And code 99395 was denied because the policy does not provide a wellness benefit.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEGATIVE] So then when we received it the 2nd time, it was denied as a duplicate.
[CUSTOMER][NEUTRAL] OK, so what is the timely filing for correct to claim?
[AGENT][NEGATIVE] There's no timely filing for a corrected claim.
[CUSTOMER][NEUTRAL] OK. So I just wanted to check that the code 99395 denied us uh it that the code uh is not provide the wellness.
[AGENT][NEUTRAL] Right, the policy does not provide a wellness benefit.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII].
[CUSTOMER][NEUTRAL] And uh
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I have, uh, do you have any policy number with you?
[AGENT][NEUTRAL] The policy number that you, um, the policy number is 226.
[AGENT][NEUTRAL] 676-3.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. Uh, may I know that policy name?
[AGENT][NEUTRAL] This is a hospital indemnity policy.
[CUSTOMER][NEUTRAL] Uh, sorry, could you please repeat that?
[AGENT][NEUTRAL] The policy name or type is hospital indemnity.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. And I have 2 more claims for different members. Could you please help me with that?
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So we have
[AGENT][NEUTRAL] And the next member's policy number?
[CUSTOMER][NEUTRAL] I have the member ID. It's D as in Delta 43509504.
[AGENT][NEUTRAL] So the D numbers are the policy number for 90 degree benefits. APL policies start with a 01 or 02 might have an ML 7 or 8 at the end. Um, I can also search this one with the social as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please check with the uh member name and date of birth?
[AGENT][NEUTRAL] I can search with the member's first and last name.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I provide you that?
[AGENT][POSITIVE] Yes, whenever you're ready.
[CUSTOMER][NEUTRAL] Mhm. First name is [PII]. It's [PII]. Last name is [PII]. It's [PII]
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so I don't, let me try one more time. Hold on one moment.
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the first name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And this is for their medical policy as well?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, wait, so we, uh.
[AGENT][NEUTRAL] Do you have the last 4 of your social?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Last four of the social.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Oh wait a minute, hold on one moment.
[AGENT][NEUTRAL] Might be this one.
[AGENT][NEUTRAL] And um, can you verify the date of birth? I'm trying to make sure this is the correct patient.
[CUSTOMER][NEUTRAL] OK. Date of birth is [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the member did have a policy with us, but it was a dental policy, so I'm not sure who their medical insurance is through.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, that's fine, you know. Can I get the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date.
[AGENT][NEUTRAL] For the entire call, the first initial to my last name is going to be [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you so much for your assistance and patience. Have a nice day, bye.
[AGENT][POSITIVE] Thank you, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] OK.