AccountId: 011433970860
ContactId: 08c7836d-2d78-43fe-9341-3371653efd37
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 562840 ms
Total Talk Time (AGENT): 192208 ms
Total Talk Time (CUSTOMER): 143823 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/08c7836d-2d78-43fe-9341-3371653efd37_20250604T21:45_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, how are you? My name is [PII].
[AGENT][NEUTRAL] How can I help you today, [PII]?
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEGATIVE] I got a bill from one of the um one of the insurance from one of the doctors and they said you guys didn't want to pay, you guys only pay $65 and they charged me $1,565.
[AGENT][NEUTRAL] OK, let me help you with that claim. Um, [PII], can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] The policy no oh my policy, OK, hold on.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's um
[CUSTOMER][NEUTRAL] 022
[CUSTOMER][NEUTRAL] 8820.
[CUSTOMER][NEUTRAL] 8
[CUSTOMER][NEUTRAL] ML 7.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify your date of birth for me please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] In the mailing address that we have on file?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And do you have the claim number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 39
[CUSTOMER][NEUTRAL] 75
[CUSTOMER][NEUTRAL] 1858.
[CUSTOMER][NEUTRAL] 59
[CUSTOMER][NEUTRAL] 91
[AGENT][NEUTRAL] And that's the claim number?
[CUSTOMER][NEUTRAL] Well, that's the um billing ID.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] When was the date of service?
[CUSTOMER][NEUTRAL] Uh, um.
[CUSTOMER][NEUTRAL] For the.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Maybe in December.
[AGENT][NEUTRAL] OK, I see one for [PII]. Does that sound about right?
[CUSTOMER][NEUTRAL] Uh, could be, yeah.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Or maybe uh [PII].
[AGENT][NEUTRAL] OK, let me look.
[AGENT][NEUTRAL] And you know what the provider or the hospital name was?
[CUSTOMER][NEUTRAL] Uh, it, it was Gastrohealth.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it looks like benefits are only payable if the major medical insurance provider provides benefits. Um, if this claim was paid by your major medical, uh, you'll need to send us an explanation of benefits showing that benefits were paid.
[AGENT][NEUTRAL] Uh, the other $60.65 dollars that we sent was, um, for one that was already covered.
[CUSTOMER][NEUTRAL] Well, uh, I
[CUSTOMER][NEUTRAL] OK, because I see here the the um the treatment was $3210 and the insurance covered $1,645.
[CUSTOMER][NEUTRAL] And uh,
[CUSTOMER][NEUTRAL] And you only pay $65.
[AGENT][NEUTRAL] Yes, it looks like um if did you send in the uh.
[AGENT][NEUTRAL] Your primary insurance or your major medical uh explanation and business with that claim?
[CUSTOMER][NEUTRAL] What do you mean?
[AGENT][NEUTRAL] So in order for benefits to be paid, we will need um an explanation of benefits or you might see it as an EOB and we'll need to see that they paid part of that claim. Oh, go ahead.
[CUSTOMER][NEUTRAL] Can you, can you
[CUSTOMER][NEUTRAL] Can you explain that to me because I don't understand the term you're using.
[AGENT][NEUTRAL] So when you have the procedure.
[AGENT][NEUTRAL] And your primary insurance or your major medical insurance covered part of it?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They would have sent you a letter in the mail showing uh what they had paid.
[AGENT][NEUTRAL] And what procedures were paid for and it's typically a letter called an explanation of benefits.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Exponential of benefits, OK.
[AGENT][NEUTRAL] Yes, and so it looks like uh we need that we need a copy of that in order to reprocess this if you think that it's if if your major medical paid for part of it, we need that explanation of benefits letter so if you don't, if you don't have it, you might need to call your major medical and ask them to send you a copy or to send us a copy on your behalf.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I will, I will call them then.
[AGENT][NEUTRAL] And would you like the claim number so that they, whoever gets the explanation of benefits, uh, you can include the claim number on there?
[CUSTOMER][NEUTRAL] OK, hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me a second. Let me, let me run and get it. Hold on. Let me get something to write with.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'll be on time.
[CUSTOMER][NEUTRAL] I'm not sure.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] OK, the claim number is 35.
[AGENT][NEUTRAL] 76.
[AGENT][NEUTRAL] 806.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, let me repeat that again.
[CUSTOMER][NEUTRAL] 35 76806
[AGENT][NEUTRAL] 35768006
[CUSTOMER][NEUTRAL] Yeah, that's 3576806.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I will call them tomorrow.
[AGENT][NEUTRAL] And then if you send that letter, yeah, we'll we'll reprocess the claim.
[CUSTOMER][NEUTRAL] What, what are, what are they called?
[AGENT][NEUTRAL] It's called an explanation of benefits.
[CUSTOMER][POSITIVE] Excellent.
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] Or if you need to you can write an EOB.
[CUSTOMER][NEUTRAL] Be
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, explanation of benefits. I, I have to tell them to, to send that, right?
[AGENT][NEUTRAL] Yes and um since and they should have our fax number otherwise um it should be on the claim whoever processed the claim uh our claim information should be on there, otherwise they'll send it to you and you can send it to us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm gonna call them tomorrow.
[AGENT][NEUTRAL] OK, is there anything else I can help you with in the meantime?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] No, that's it. No, that's it.
[AGENT][NEUTRAL] What?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Right, [PII], well, thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] OK, a question from what time to what time you guys always open?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] We are open from [PII] and that's central.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] OK, you're welcome. Thank you for calling ATL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.