AccountId: 011433970860
ContactId: 094114ca-e7a8-47c3-9cf5-4ddd2edf61cd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 517979 ms
Total Talk Time (AGENT): 132125 ms
Total Talk Time (CUSTOMER): 191735 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/094114ca-e7a8-47c3-9cf5-4ddd2edf61cd_20250303T16:08_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL Tory.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hi, I need to check status of a medical claim.
[AGENT][NEUTRAL] OK, I can help you with claim status. Can I please get your name and your callback number?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] My name is [PII]. I'm with Carl Foundation House. So the callback number is [PII]. That is a direct line. And what is your name?
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] I'm sorry, you're fading every time you say your name. I'm sorry. Say it again.
[AGENT][NEUTRAL] I'm sorry. My name is [PII].
[CUSTOMER][POSITIVE] [PII], thank you.
[AGENT][NEUTRAL] You're welcome. What's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth.
[CUSTOMER][NEUTRAL] Oh well, that was their date of birth I gave you that. I'm sorry, [PII], um, but the ID number is 2,355,140.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, let me pull that up real quick.
[AGENT][NEUTRAL] OK, and then what is [PII]'s um date of service and charge amount?
[CUSTOMER][NEUTRAL] [PII] $688.
[AGENT][NEUTRAL] OK and then um can you repeat the name of the facility please one more time for me?
[CUSTOMER][NEUTRAL] Carl Foundation Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I pull up this claim for you and I'll be right back.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you so much for holding for me, Miss [PII]. So looking on data service of [PII], I do not find the claim on file for the amount that you have given me.
[CUSTOMER][NEUTRAL] Um, let me make sure the amount, um, $688. OK, now we called back and um looks like I called on this previously, um, and I was told I think that same information, um, that was back in [PII].
[CUSTOMER][NEUTRAL] Um, I, I, you know, they told me to, um,
[CUSTOMER][NEUTRAL] But actually, you know what, when I called, it was on, on [PII]'s birthday, I mean, holiday, so I don't think I talked.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, however, someone did call was told, can you hear me?
[CUSTOMER][NEUTRAL] Ma'am.
[AGENT][NEUTRAL] Yes I can hear you.
[CUSTOMER][NEUTRAL] Hello? Oh, OK. Yeah, someone did call. Looks like they just called, uh, yeah, it looked like they just called in January and they were told that that ID number is not valid for American Republic. Is that true?
[AGENT][NEUTRAL] Yes I can hear you.
[AGENT][NEUTRAL] Uh, no, I do find that policy number, the 235-514-0.
[CUSTOMER][NEUTRAL] 235-5140, yeah that.
[AGENT][NEGATIVE] But I do not find the amount that you have given.
[CUSTOMER][NEUTRAL] So no claim with the amount. What's your time is.
[AGENT][NEUTRAL] It's not the same amount.
[CUSTOMER][NEUTRAL] What's your timely filing?
[AGENT][NEUTRAL] Uh, we do not have one. You can as long as the patient was covered on the data service, you can file at any time.
[CUSTOMER][NEUTRAL] Well, and then on, on here, we have IMA as the insurance. Are you guys affiliated with IMA?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, so are you guys the repricer?
[AGENT][NEUTRAL] Mm, I've never been asked that question before.
[AGENT][NEUTRAL] I mean I do show that we do have a claim on file for your.
[CUSTOMER][NEUTRAL] OK, so, uh, uh-huh.
[AGENT][NEUTRAL] Um, for [PII]'s physician group, but it's not the same amount that you've given me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it's already been paid.
[CUSTOMER][NEUTRAL] OK, but American, OK, so Ame American Public Life is the insurance we need to bill. And what's the patients affected today under the plan?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] The effective date is.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the policy lapsed.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] OK, but they were covered for the data service and, and then it would, it reinstated or did it ever reinstate after the lapse?
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, ma'am. It, it did not reinstate.
[CUSTOMER][NEUTRAL] OK, but they were eligible for the day the service of [PII]. Alright, um, is there a way I can fax the claim or it has to be mailed?
[AGENT][NEUTRAL] Yes, let me give you that fax number.
[AGENT][NEUTRAL] The fax number is [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK, 18, 1 was 877365-9423.
[AGENT][POSITIVE] Yes ma'am, that's correct.
[CUSTOMER][NEUTRAL] OK, alright, I'll go ahead and just have the claim fax out there since um.
[CUSTOMER][NEUTRAL] Because I think we initially would have electronically filed the claim and then we would then we would have turned around and mailed it and with the address we have is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is that the correct mailing address?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK. All right, and I just need, uh, I just need a reference number.
[AGENT][NEUTRAL] Yes ma'am, you can use my name. It's [PII] in today's date.
[CUSTOMER][POSITIVE] OK, thank you very much. Have a great day.
[AGENT][POSITIVE] You too, Ms. [PII]. I hope you have a blessed one. Thanks for calling APL.
[CUSTOMER][NEUTRAL] OK, bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.