AccountId: 011433970860
ContactId: ff050524-abe8-49bf-997d-079d99bc88d5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 908770 ms
Total Talk Time (AGENT): 275051 ms
Total Talk Time (CUSTOMER): 160753 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/ff050524-abe8-49bf-997d-079d99bc88d5_20250127T18:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office checking on claim status. Could you please help me with that?
[AGENT][NEUTRAL] Yeah, I can check on a claim for you. You said your name was [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII]'s direct line.
[AGENT][NEUTRAL] Alright, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah. 01792144.
[AGENT][NEUTRAL] OK, thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that, [PII]. And what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII] and the bill amount $129 even.
[AGENT][NEUTRAL] OK, that was [PII] for $129.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[AGENT][NEUTRAL] OK, and uh I'm sorry, what was the name of the uh provider's office?
[CUSTOMER][NEUTRAL] Mercy Clinic.
[AGENT][NEUTRAL] OK, thank you. Alright, so I did find this claim [PII], we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know when it, when the claim was received and processed?
[AGENT][NEUTRAL] Yes, uh, the claim was received [PII].
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][POSITIVE] Thank you. One moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] May I know the timely filing limit?
[AGENT][NEGATIVE] Uh, there is no timely filing limit.
[CUSTOMER][NEUTRAL] OK. Could you please spell out your name?
[AGENT][NEUTRAL] It's [PII] Last initial is [PII]
[CUSTOMER][POSITIVE] Thank you. I have 4 more claims. Could you please help me with that?
[AGENT][NEUTRAL] Are these for different members or these for the same member?
[CUSTOMER][NEUTRAL] Different.
[AGENT][NEUTRAL] OK, give me one moment, um, did you need this claim number [PII] before we continue?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, this claim number was 348-0311.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Of course, one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I am ready for that next policy number.
[CUSTOMER][NEUTRAL] 02145086
[AGENT][NEUTRAL] OK and uh what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] Alright, thank you for verifying that. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII] and the bill of $181 even.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, I'm sorry, that was [PII]?
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] [PII]. OK, sorry about that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] Alright, so for this claim, [PII], we were unable to pay a benefit as uh their policy terminated, uh, [PII].
[AGENT][NEUTRAL] So the services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] May I know the effective date?
[AGENT][NEUTRAL] Yes, uh, this policy's effective date was [PII].
[CUSTOMER][NEUTRAL] May I know when the claim is received and processed?
[AGENT][NEUTRAL] Yes, let's see.
[AGENT][NEUTRAL] This claim was received [PII], and it was processed on [PII].
[CUSTOMER][NEUTRAL] May I know the number?
[AGENT][NEUTRAL] Yes, that claim number is 34.
[AGENT][NEUTRAL] 80501.
[CUSTOMER][NEUTRAL] Thank you. Could you please send me a copy of EOB?
[AGENT][NEUTRAL] Yes, uh, give me just a moment.
[AGENT][NEUTRAL] OK, uh, what was that fax number for you, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then but I just put this to your attention?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK, let me go ahead and get that sent to you right now.
[AGENT][NEUTRAL] OK, so I did just send that [PII], um, and we can.
[AGENT][POSITIVE] Continue to the next one whenever you are ready.
[CUSTOMER][NEUTRAL] Yeah, moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] Sure, you're fine.
[CUSTOMER][NEUTRAL] Yeah, the next one.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And the uh name and date of birth for this number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that and what was the date of service?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the bill amount $257 even.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] So I did find this claim, uh, this one we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Thank you. May I know when the claim was received and processed?
[AGENT][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] OK, this claim was received [PII], and it was processed [PII].
[CUSTOMER][POSITIVE] Thank you. Shall we move to the next one?
[AGENT][NEUTRAL] Uh, one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, did you need this claim number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, it is 34.
[AGENT][NEUTRAL] 96
[AGENT][NEUTRAL] 095.
[AGENT][NEUTRAL] And then I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] 34
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 34965, right?
[AGENT][NEUTRAL] 349-6095
[CUSTOMER][POSITIVE] Thank you. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the next 1018.
[CUSTOMER][NEUTRAL] 22 3 46.
[AGENT][NEUTRAL] OK and the uh name and date of birth for this number?
[CUSTOMER][NEUTRAL] [PII], and the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you for that and then what was the date of service please?
[CUSTOMER][NEUTRAL] [PII] and the bill amount $184.
[AGENT][NEUTRAL] OK. One moment, please.
[AGENT][NEUTRAL] OK, so for this one as well, [PII], we were unable to pay a benefit as office visits are not covered.
[CUSTOMER][NEUTRAL] May I know when the team was received and processed?
[AGENT][NEUTRAL] Mhm it was received [PII].
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][POSITIVE] Thank you. Can we be a patient for this?
[AGENT][NEUTRAL] We do not say what is patient responsibility, that would be up to the provider.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Shall I move the last one?
[AGENT][NEUTRAL] Did you need this claim number first?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, it is 34.
[AGENT][NEUTRAL] 62
[AGENT][NEUTRAL] 811.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, OK. And then I'm ready for that policy number.
[CUSTOMER][NEUTRAL] 1462925.
[AGENT][NEUTRAL] OK, and the uh name and date of birth for this number?
[CUSTOMER][NEUTRAL] [PII] and the date of birth [PII].
[AGENT][POSITIVE] Thank you and then uh the date of service please.
[CUSTOMER][NEUTRAL] [PII] and the build amount $184 even.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] So this one, we were also unable to pay a benefit as office visits are not covered.
[CUSTOMER][NEUTRAL] And when the claim was received and processed?
[AGENT][NEUTRAL] Yes, this claim was received [PII].
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, did you need the claim number? Yes, it is 3474.
[CUSTOMER][NEUTRAL] And the claim number?
[AGENT][NEUTRAL] 354.
[CUSTOMER][NEUTRAL] Thank you. May I know the call reference?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No, that's all for today. Thank you. Have a good day.
[AGENT][POSITIVE] OK, yeah, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye bye.