AccountId: 011433970860
ContactId: fffa60b3-f90e-4cf7-a040-8c4bb96824fd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1253290 ms
Total Talk Time (AGENT): 512670 ms
Total Talk Time (CUSTOMER): 627582 ms
Interruptions: 25
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/fffa60b3-f90e-4cf7-a040-8c4bb96824fd_20250219T19:14_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I'll.
[CUSTOMER][NEUTRAL] Yes, hi, I'm calling from Day and night Pediatrics, and I'm trying to, um, uh, check on some claims that have, um, that are still outstanding in our office.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, if you can help me with that, I, I have, I have about 3 different, um, patients that I need to check into.
[AGENT][NEUTRAL] OK, yeah, I can look at those claims for you.
[CUSTOMER][POSITIVE] Um, OK, perfect. Let's start with Mr. [PII].
[AGENT][NEUTRAL] OK, um, one moment, I'm sorry, really quick, what was your name?
[CUSTOMER][NEUTRAL] [PII] from Day and Night Pediatrics.
[AGENT][NEUTRAL] [PII], OK, and then can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] I do. OK, so first policy number would be 0167870 I mean 80 ML8. [PII] Date of birth [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you and then uh I'm sorry, what was the name and date of birth for the member?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Got
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, and were there multiple for [PII] or was it um just the one for him?
[CUSTOMER][NEUTRAL] For for.
[CUSTOMER][NEUTRAL] Just the one for him.
[AGENT][NEUTRAL] OK, and what was that, uh, you said that was 1015 24, what was that bill amount?
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] 2 weeks.
[CUSTOMER][NEUTRAL] The bill amount was 48765 cents. What was left for [PII] should be like a co-payment type of payment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, OK, one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] And no rush for you you know what he likes.
[AGENT][NEUTRAL] OK, I know you said this was a day and night pediatrics you said do you have the uh tax ID?
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yes, I do. One moment please.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Sorry, there's a lot of conversation here. OK, tax ID is [PII].
[AGENT][NEUTRAL] You are fine.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, got it. So we've got that as a vital MD group holding. So, OK, got it. So we did receive this claim give me just a moment let me get this information pulled up.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Correct, mhm.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][POSITIVE] Congratulations for [PII]. Thank you for.
[AGENT][NEUTRAL] OK, so it looks like we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][POSITIVE] So cute
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you need that EOB I can send that to you.
[CUSTOMER][NEUTRAL] Can you fax it over to us?
[AGENT][NEUTRAL] Of course what's that fax number for you?
[CUSTOMER][NEUTRAL] The fax number is [PII].
[CUSTOMER][NEUTRAL] [PII] 7
[CUSTOMER][NEUTRAL] [PII] mhm and well I'm sorry, can you give me that explanation again?
[AGENT][NEUTRAL] [PII] 7.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, yeah, office visits are not covered under this policy, so we were unable to pay a benefit. Um, really quickly I'm going to read back that fax number, make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, OK, let me go ahead and get that sent to you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, and did you need any other additional information um for this claim?
[CUSTOMER][NEUTRAL] For this one, no, I, what I need is your name and a reference number for this claim. Should we go, how should we?
[AGENT][NEUTRAL] But the
[AGENT][NEUTRAL] No, that's fine. So the reference number would just be the same throughout, uh, so it's going to be my first name, last initial, and today's date. Uh, so my name is spelled [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Yes, and then uh today's date.
[CUSTOMER][NEUTRAL] And today's date is [PII]. That's the reference number and your name is [PII], right? OK.
[AGENT][NEUTRAL] Uh, mhm.
[AGENT][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Alrighty, give me just a moment, I'll let you know when I'm ready for that next, uh, policy number.
[CUSTOMER][NEUTRAL] And what date did you receive that and and process what um yes I'm sorry.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh, sure.
[AGENT][POSITIVE] Let me get that for you, no worries, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That was received [PII], and it was processed [PII].
[CUSTOMER][NEUTRAL] Yeah, so you said to me like uh.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me just a moment, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and I am ready for that next policy number.
[CUSTOMER][NEUTRAL] Next policy number is 0163.
[CUSTOMER][NEUTRAL] 491 2
[CUSTOMER][NEUTRAL] ML 7.
[AGENT][NEUTRAL] Got it thank you and then what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Perfect thank you and then what was the date of service for this one?
[CUSTOMER][NEUTRAL] We'll be 6 and he'll be.
[CUSTOMER][NEUTRAL] Day of service is [PII].
[CUSTOMER][NEUTRAL] Of [PII].
[AGENT][NEUTRAL] OK and then uh that bill amount please.
[CUSTOMER][NEUTRAL] Uh, bill amount is 474.
[AGENT][NEUTRAL] 474.
[CUSTOMER][NEUTRAL] Mhm, 474.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, I'm sorry, that was, oh goodness, that's why oh my sorry, the policy number you gave me was a bit old, um, they didn't have active coverage at that time I was like, oh we didn't even receive it. Give me just a moment. No, no, they do have one that is active during that time. Bear with me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] phone.
[CUSTOMER][NEUTRAL] No, no, no, OK.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I believe I found it. Give me just a moment.
[AGENT][NEUTRAL] OK, yes, so for this claim, we did pay a benefit of $56.84. Uh, we were unable to make a payment on procedure code 99214 as this policy also does not cover office visits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, covered office is it, but you did pay the 5684.
[AGENT][NEUTRAL] I'm sorry, [PII], it sounds um the microphone sounds a bit far away. I can't hear you very well.
[CUSTOMER][NEUTRAL] OK, but you did pay the 56. I'm sorry, you did pay the 5684?
[AGENT][POSITIVE] Oh that's much better thank you.
[AGENT][NEUTRAL] No, that's OK.
[AGENT][POSITIVE] Correct, I can give you that check information.
[CUSTOMER][NEUTRAL] And when it was paid, the date of payment.
[AGENT][NEUTRAL] Of course one moment.
[AGENT][NEUTRAL] Yes, OK, so, um, I've got that check number if you needed it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's 2018473.
[CUSTOMER][NEUTRAL] Mhm. Mhm. Mhm. And no, no, go ahead, it was issued.
[AGENT][NEUTRAL] Alrighty and so that check was issued oh sorry go ahead.
[AGENT][NEUTRAL] Yes, [PII]. I am showing it has not yet cleared, so I can go ahead and void and reissue this check. Um, let me verify the address that we sent it to whenever you're ready.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Any.
[CUSTOMER][NEUTRAL] Um, go ahead.
[AGENT][NEUTRAL] OK, so I've got [PII], is that correct?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Right, so that, that's, that's because, um, [PII] gets, uh, the actual you sent it, uh, to them not our office directly but that's fine. I, we, they eventually give us the information, um.
[AGENT][NEUTRAL] OK, so when it's uh reissued it it's OK to send it to this address?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, yes, mhm.
[AGENT][NEUTRAL] OK, OK, so I'll go ahead and have this.
[CUSTOMER][NEUTRAL] So it's not clear you're gonna be.
[AGENT][NEUTRAL] Yes, I'm going to go ahead and have that, yes, yes, unless you think it's there and you could just easily get it, um, but typically once it's reached that 30 day mark after um it's been issued and it hasn't cleared we can go ahead and reissue that.
[CUSTOMER][NEGATIVE] You're gonna void it and then we resend it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, perfect. And then will you be able to fax us an email on that or no?
[AGENT][POSITIVE] Of course, yeah, I can send you the EOB as well. Give me just a moment, I'll get that sent right now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thanks so much.
[AGENT][NEUTRAL] OK, and did you need any further information regarding this claim? Did you need, uh, when we received it?
[CUSTOMER][NEUTRAL] Um, yes, please.
[AGENT][NEUTRAL] OK, just a moment, let me get that for you.
[AGENT][NEUTRAL] OK, so this claim was received [PII], and it was processed [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, right. Now there, there are two other line breakdowns for for this actual claim. Can I give you the number and you know, um, and you tell me what the, the, the reason behind the, the line breakdown, the, the why it has not been paid.
[AGENT][NEUTRAL] OK, and then I can go ahead, sure.
[AGENT][NEUTRAL] For this particular claim?
[CUSTOMER][NEUTRAL] Because it you said 99214 is not covered, but how about um line 87,880.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, we did pay all of the other ones, so for 87,880 we paid $19.96.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For 878-04 we paid $18.44 well both there were two I guess um 87804 that was an additional 1844 as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so an additional 1844. OK, alright, perfect. OK, um, OK, so that one should be done, that information, yeah, I have more than enough information for that one, OK.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Right, um,
[AGENT][NEUTRAL] OK and so as soon as we get off of the phone once we finish this up I'll put in that request to have that voided and reissued to you um so let's go ahead and we can proceed to the next one.
[CUSTOMER][NEUTRAL] OK, the next one is member ID 01935547.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what was the name and date of birth for this member?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for that and then uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] OK and the bill amount please?
[CUSTOMER][NEUTRAL] 342.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, let's see, so for this one there are the two items, so we were unable to pay a benefit on the 99213 as again office visits are not covered under this policy. As for uh the code 87,880, um, it looks like we're missing the primary EOB.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To be able to process that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then, um, your balance would have been what? 72 by chance or you don't even that doesn't show you a breakdown.
[AGENT][NEUTRAL] Well, from what we've received, um, I've got that office visit the 99213 at $300 which of course we would be unable to pay, um, the 87,880 I've got it $42.
[CUSTOMER][NEUTRAL] At 42.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you want me to send you this EOB as well, [PII]?
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK, let me go ahead and get that sent.
[AGENT][NEUTRAL] Alrighty and then uh did you need the receiving process date for this one as well?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK, uh, so this claim was received [PII], and it was processed [PII].
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEGATIVE] I wish there was a way of like push to pay and then once we receive payment that's initiate.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the balance is 42, not.
[CUSTOMER][NEUTRAL] OK, that's uh.
[AGENT][POSITIVE] For what we could uh potentially pay yeah.
[CUSTOMER][POSITIVE] Right, 42. OK, perfect.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so that one's that, um, I have one more if you can please help me with that one.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, give me just a moment if you would I'll let you know when I'm ready for that thank you.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] I said she's very.
[CUSTOMER][NEUTRAL] No, it's mine.
[CUSTOMER][NEUTRAL] No, I have no idea what it is.
[CUSTOMER][NEUTRAL] I've been getting all these weird calls lately.
[CUSTOMER][NEUTRAL] I know if the if it continues to call or if it leaves a message then it's something that I need to answer.
[CUSTOMER][NEGATIVE] Oh no.
[AGENT][NEUTRAL] OK, and I am ready for that last policy number.
[CUSTOMER][NEUTRAL] The last policy number is 1165426.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Olivia [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Um, let's see, hang on, I don't think I heard that policy number correctly. Was that 1165426?
[CUSTOMER][NEUTRAL] I, I can't see you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I think we are missing a digit. We are.
[CUSTOMER][NEUTRAL] A couple of numbers.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, let me check, give me a second to check inside into.
[AGENT][NEUTRAL] One in particular.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, give me a second, let me go into there.
[CUSTOMER][NEUTRAL] Yeah, it's, it looks short, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see what's going on here. [PII].
[CUSTOMER][NEUTRAL] And info.
[CUSTOMER][NEUTRAL] No 1165426.
[AGENT][NEUTRAL] Well, I'm getting a policy but it is definitely not for that member um, let's see, do you maybe have a, I'm sorry?
[CUSTOMER][NEUTRAL] Could it be for her?
[CUSTOMER][NEUTRAL] A parent, it could be a parent, [PII].
[AGENT][NEUTRAL] Yes, OK, so let me, give me just a moment actually, let me see, what was the insured's name? I'm sorry, you said [PII]?
[CUSTOMER][NEUTRAL] OK, that's apparent.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII], mhm.
[AGENT][NEUTRAL] OK, give me just a moment let me see if there's one that's more recent that might have [PII] on there.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Right, so [PII] was born in [PII], so it could be the mother's secondary policy that she has her daughter, right, mhm.
[AGENT][NEUTRAL] That's it, yep, I found it. I found it. OK, did you want that, uh, correct policy number for your records?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Yes please, yes please.
[AGENT][NEUTRAL] OK, so it is 01854361.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 01854361
[AGENT][NEUTRAL] Correct and so this one's effective date was [PII]. It is currently active, um, OK, and then what was the date of service for [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK and then uh that bill amount please.
[CUSTOMER][NEUTRAL] Hi, I'm calling to
[CUSTOMER][NEUTRAL] 1,811 with 90 cents.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Got it thank you one moment.
[CUSTOMER][NEUTRAL] I believe that's probably vaccines.
[CUSTOMER][POSITIVE] Thank you got it.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Do you have to.
[CUSTOMER][NEUTRAL] So you have to do
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK, let's see
[CUSTOMER][NEUTRAL] What happened
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] to
[AGENT][NEUTRAL] Bear with me just a moment.
[CUSTOMER][NEUTRAL] No it's fine
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] It looks like she had a few claims for that date of service. I just wanna make sure I found the right one.
[CUSTOMER][NEUTRAL] Right, so I'm looking for particularly the line G 0473.
[AGENT][POSITIVE] That is helpful and I do believe I got it. OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] So for that item, we, let's see.
[AGENT][NEUTRAL] It does say uh the policy provides no benefits for the treatment of conditions other than a sickness or an injury as defined by the policy.
[CUSTOMER][NEGATIVE] OK, so no benefit.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And I could go ahead and send you this EOB as well.
[CUSTOMER][NEUTRAL] Unless
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And when was that, um, processed and paid?
[AGENT][NEUTRAL] Yes, one moment. Mhm.
[CUSTOMER][NEUTRAL] I received them.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 64 so this one was received [PII].
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] That's it, OK.
[CUSTOMER][POSITIVE] So that's that those are the, that's everything that you have given me has been perfect.
[AGENT][POSITIVE] Alrighty, glad we were able to track them all down. Did you have any other questions for me?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that's it. Thank you very, very much. You have a wonderful day.
[AGENT][POSITIVE] Alright, oh, you're very welcome, [PII]. I hope you have a great rest of your day. Thank you.
[CUSTOMER][POSITIVE] You too bye bye. OK, thank you, bye bye.
[AGENT][NEUTRAL] All right, bye-bye.