AccountId: 011433970860
ContactId: 22e568f1-20ff-46f8-8b04-a68c7fd495dc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 646799 ms
Total Talk Time (AGENT): 284333 ms
Total Talk Time (CUSTOMER): 291324 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/22e568f1-20ff-46f8-8b04-a68c7fd495dc_20250604T13:15_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, well, I was, first off, I was trying to log in online and my login isn't working. I think they've changed the, changed the, the.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] The way to log in and it's not recognizing my email but that's um.
[CUSTOMER][NEUTRAL] The, my, my actual issue that I was trying to walk in and look at is, um, I was, had a claim put in, uh, I put in a claim for, uh, it would be, it would show up under, uh,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Chippenham Hospital. And it was, there were benefits, uh, you know, I have, I got the EOB and there were benefits paid, but they didn't come to me or I never received them. I need to find out if that money got sent to the hospital or what happened.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] I certainly look at that. I can certainly look at your claim. Uh, what is your policy number, please?
[CUSTOMER][NEUTRAL] My oh, OK, I'm sorry, I don't have my card in front of me. Give me a second here.
[AGENT][NEUTRAL] OK, well, I can look it up by your social security number or your name if you don't mind spelling your last name for me, please?
[CUSTOMER][NEUTRAL] OK, I can give you my social. It is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]. Thank you. If I could verify your name, date of birth and the phone number please, ma'am?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Of [PII], [PII]
[AGENT][NEUTRAL] OK, thank you. I'm just trying to put this.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] As soon as I asked that the.
[AGENT][NEUTRAL] Excuse me just a moment, be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you so much. I, yeah, yes, hi. It just took me a moment to, uh, to find that, um, in fact, I appreciate that. So I'm just looking at your policy now.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Um, so you said that there was a claim that uh that you had submitted.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what data of service is it that we should be looking at for this claim?
[CUSTOMER][NEUTRAL] Uh, see, I don't know what the date it was over, it was a, it, it was a psychiatric program, so it was over a period of time. Um.
[CUSTOMER][NEUTRAL] I had
[CUSTOMER][NEUTRAL] Let me see if I can find where I saved.
[CUSTOMER][NEUTRAL] OK, no, that's.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] I know I had it and I saved it.
[AGENT][NEUTRAL] But this is for 2
[CUSTOMER][NEGATIVE] I'm sorry, I'm disorganized. I should have had this.
[AGENT][NEUTRAL] No, no, that's fine.
[AGENT][NEUTRAL] This is for 2024, is it not? This is for last year. Does that sound right?
[CUSTOMER][NEUTRAL] Available
[CUSTOMER][NEUTRAL] Uh, it was 2024 correct.
[AGENT][NEUTRAL] OK, let me tell you what I've got and then, and then we can see whether um the the last claim that I have, um, I'm just pulling it up now and perhaps this is the one that we are looking at, um.
[AGENT][NEUTRAL] It was for uh
[AGENT][NEUTRAL] Chippenham Hospital for [PII].
[CUSTOMER][POSITIVE] That's correct, that's the one I'm looking at.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] So let's see what we have here.
[CUSTOMER][NEUTRAL] Because I got a letter saying that there wasn't, you know, that you hadn't gotten the um.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] And some insurance information, you know, the primary insurance information, and I uploaded that and I didn't have the bill anymore for uh for once in my life, I lost, uh, you know, the bill stub from, uh, but I emailed the
[AGENT][POSITIVE] Yes, of course.
[CUSTOMER][NEUTRAL] the canceled check and showed it and a copy of where it came up on
[CUSTOMER][NEUTRAL] Where the where the payment that I made to them came up on the bank statement so you could see that I paid for it.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Absolutely, so that.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Yeah, I, I do see that. I see that on, uh, [PII], uh, Chippenha sent us a bill, uh, that they did not send us the explanation of benefits. Um, we do show that you sent the EOB on, uh, [PII]. Now whenever something like this happens, uh, if, if you are the only one who submits the bill or a claim, then we pay make the payment to you. In this case, [PII], the, the, uh, provider.
[AGENT][NEUTRAL] Did send in a claim, they just didn't submit the EOB and because of that we sent the payment to them. Now we sent the payment uh to them on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Now, what we did was that that uh
[CUSTOMER][NEUTRAL] OK, so I need to call them.
[AGENT][NEUTRAL] Yes, ma'am. Now what that did was that maxed out your benefits uh for the calendar year [PII]. So we paid them $1,366.78. Their bill was for $1,744. So let's just look at this really quickly.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] 777.
[AGENT][NEUTRAL] Absolutely, so there's gonna be a little bit that's gonna be left over, but that was paid, um, so, uh, you know, I think probably you might be getting a bill, right, yeah, it was paid to the hospital, you might be getting a bill for maybe $400 377 dollars, something like that. That's only because, um, you're.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] She was paid to the hospital.
[CUSTOMER][NEUTRAL] No, see, I had paid, I had already paid the 1777.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] 00.
[CUSTOMER][NEGATIVE] So they, they just owe me back the $1300 that they got from you. Because I don't know what happened because I got the bill for the 1,777 and I paid it and then was.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] To put in the claim with you all, but then I saw the claim was placed, and that's why I sent you proof of payment so that you would know that the money needed to come to me because I had already paid it to the hospital.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So, um, but I guess that didn't happen.
[AGENT][NEUTRAL] Yeah,
[AGENT][NEUTRAL] Well, what, what, what would have happened in that case is that um even if you send us something showing that you had already paid the provider.
[AGENT][NEUTRAL] Uh, because they send in that, that first claim.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] We've got to pay
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so we're under obligation at that point to pay them uh because they sent in the claim, uh, like a week or so before, before you sent your documents. Now let's just say that it was it was the other way around. Let's say that you had made that if this what this is is first come first pay. So if you'd send in the claim first.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, we would have paid you, uh, but in this case, uh, and we do, we do show that you made that payment, we do see that, um, but we're under obligation to pay the, the provider because they send in that, that, you know, that excuse me, that, that, uh, UB or, or, or, um, claim form, hospital claim form first.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, so, um, that is what has happened with this, uh, they did get that it's, uh, $1,366.78.
[AGENT][NEGATIVE] And uh unfortunately,
[CUSTOMER][POSITIVE] OK. Well, I will go, I will just call them and see if, cause they'll show it as a credit on my account, I'm sure, because they got the money. But they got that money after they had gotten mine. And obviously, you know, without me going after it, they're not gonna want to give it up. So.
[AGENT][NEGATIVE] I definitely need to get it back.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Right
[CUSTOMER][POSITIVE] All right. Well, thank you for your help. I will give them a call now then.
[AGENT][POSITIVE] Yeah, I'm sorry about that
[AGENT][NEUTRAL] [PII], is there anything else that I can help with? Any other, any other plan that we need to look at?
[CUSTOMER][NEGATIVE] So, well, the log on problem. I don't know why I can't log in. I tried to do the forget your password and it's not recognizing my email address.
[AGENT][POSITIVE] Yeah, I'm sorry.
[AGENT][POSITIVE] Thank you so much for reminding me of that. I knew that we needed to, I knew that there was something else we needed to do. So what we ended up doing is earlier this week, we launched an all new um uh website.
[AGENT][NEUTRAL] And uh it is more interactive uh as far as the uh insured go you you will be able to find things faster. Uh, there's, there's a lot of wonderful things about this unfortunately you do have to recreate your, um, your log on and your yeah, so when you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I need to do the create your OSC account.
[AGENT][POSITIVE] Yes ma'am, please, if you will do that and then uh and then if this is more interactive you'll be able to to uh to see more things but that's, yeah, any time that they redo them like that, uh, yeah, we'll just have to start all over again, uh, for that, but it's, it's an easy process so if you'll do that please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] And if you do have any questions, uh, logging in again, please let us know.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. I will do that. Thank you very much for your help. You've got me all the information I needed.
[AGENT][POSITIVE] OK, well thank you for contacting A.
[AGENT][POSITIVE] OK, great. Well, thanks for contacting us. You have a very good morning.