AccountId: 011433970860
ContactId: 0818971b-534d-4b01-964d-0598f16a3deb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 733080 ms
Total Talk Time (AGENT): 177309 ms
Total Talk Time (CUSTOMER): 128142 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/0818971b-534d-4b01-964d-0598f16a3deb_20250512T14:43_UTC.wav
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[AGENT][POSITIVE] Thank you for
[AGENT][NEUTRAL] Calling ATL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] with Christopher Rural Health Clinic, and I am calling to um to get a status on a claim.
[AGENT][NEUTRAL] OK, I can help you with the claim, Miss [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] May I please get your callback number ma'am just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Uh yes, it's [PII] and that's my direct line.
[AGENT][POSITIVE] Thank you so much. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, patient's name is [PII] Date of birth is [PII]. Policy number is 024483772.
[AGENT][NEUTRAL] OK, let me pull in that policy for us real quick.
[AGENT][NEUTRAL] OK and then can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Date of service is [PII]. Charged amount is $150.
[AGENT][NEUTRAL] OK, Miss [PII], I'm gonna put you on a quick hold while I look up this claim for us and I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, Ms [PII]. I've got your claim information ready for you. Uh, the claim number, ma'am is 355-0501.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was paid on [PII] and it was paid to the member.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so, um, can I go ahead and get that EOB?
[AGENT][NEUTRAL] Yes ma'am, you can get the EOB um may I please get your fax number so I can fax that over to you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, it's [PII]. So what did they pay?
[AGENT][NEUTRAL] $75.
[CUSTOMER][NEUTRAL] 75 to member, OK, so that's patients responsibility.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] We don't give patient responsibility we, we let the uh member um I'm sorry, the provider determine that information as to whether or not they wanna bill the patient.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm gonna put you on a quick hold while I get this uh claim I'm sorry, this EOB faxed over to you and I'll be right back.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK perfect thank you.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi, Ms. [PII]. I'm sending that over to you now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry you had to wait a little bit. My computer was thinking too hard and it kind of froze up for a minute.
[CUSTOMER][NEUTRAL] Right, um, and also I'm looking for another claim, um.
[CUSTOMER][NEUTRAL] Another EOB from um [PII].
[CUSTOMER][NEUTRAL] Of [PII] on the same patient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] For $150.
[AGENT][NEUTRAL] Also for $150. OK, I'm gonna put you on a quick hold and look that one up while this other one's trying to send over to you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much for holding for me, Ms [PII]. So looking at this claim, I do see that um.
[CUSTOMER][NEUTRAL] Sign a bill and
[AGENT][NEUTRAL] We're waiting for um eligibility from benefits and a card on this one and once we receive the eligibility for the data service we'll be able to process the claim automatically.
[AGENT][NEUTRAL] Wait a minute. Let me look a little closer. Actually,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm digging deeper and I do see that the insured was not eligible on that data service and the policy did lapse on [PII]. Let me see if there's any other active policies.
[AGENT][NEUTRAL] No, ma'am. There's not.
[CUSTOMER][NEUTRAL] OK, so, so the coverage term.
[AGENT][NEUTRAL] Right, the coverage termed on [PII]. Yes, ma'am, that's correct.
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] OK, then that would be then this needs to go to the patient.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Because we have another data service after that.
[AGENT][NEUTRAL] OK. What's
[CUSTOMER][NEGATIVE] That has not that we billed to you guys and we haven't received anything.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So let me go ahead and look into that and see if we have anything.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] No, that's the only insurance that we have.
[CUSTOMER][NEUTRAL] For the patient.
[CUSTOMER][NEUTRAL] OK, I'll go ahead and get these billed to the patient then um thank you.
[AGENT][POSITIVE] OK. You're so welcome, Ms. [PII], and that,
[CUSTOMER][NEUTRAL] And what's the reference?
[AGENT][NEUTRAL] You can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] OK perfect thank you.
[AGENT][POSITIVE] Uh, you're welcome is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] Uh, nope, I believe that's it. Thank you. Have a good day.
[AGENT][POSITIVE] OK, well you have a, you have a wonderful week, Ms. [PII], and thank you for calling APL.
[CUSTOMER][POSITIVE] You too you too thank you bye.
[AGENT][NEUTRAL] Bye bye, ma'am.