AccountId: 011433970860
ContactId: 24012398-c73a-45a9-b667-f41fdb19a353
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 355980 ms
Total Talk Time (AGENT): 167817 ms
Total Talk Time (CUSTOMER): 97537 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/24012398-c73a-45a9-b667-f41fdb19a353_20250108T17:52_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Doctors Hospital of Augusta. Calling to inquire about a medical claim we submitted.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] We have 02446528.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And any oh excuse me, [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Day of services [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The bill amount is $86,239.13.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so you said the total bills amount is $86,239 with data service 10-11, 2024, is that correct?
[CUSTOMER][POSITIVE] Correct, 13 cents on there as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I'm sorry, I didn't say that, but I do have that down. Yes, ma'am. We do not have a claim on that. We do not have a claim on file for Mr. [PII] for that data of service and that build out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so let's see if we send it to the right place. What is the billing address?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] The correct mailing address for claims is going to be [PII].
[AGENT][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, that is where we sent it.
[AGENT][NEUTRAL] Yes, we do not have a claim for that bill's amount. What is the facility name?
[CUSTOMER][NEUTRAL] Doctor's Hospital of Augusta.
[AGENT][NEUTRAL] Yes ma'am, we don't have a claim for that provider.
[CUSTOMER][NEUTRAL] OK, is there, uh, any other, OK, any other way we can submit it or does it need to be mailed?
[AGENT][NEUTRAL] For that data service.
[AGENT][NEUTRAL] No, ma'am, it can also be faxed. It can be faxed to [PII] attention claims.
[AGENT][NEUTRAL] And we will have to have a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Since this is a supplement.
[CUSTOMER][NEUTRAL] You're not a primary.
[AGENT][NEUTRAL] No, ma'am. We're not a major medical carrier. This is a supplemental insurance to his primary health care.
[CUSTOMER][NEUTRAL] OK, do you happen to know what his primary health care is because we do not have that information and we're trying to bill you as primary.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] We showed it for his employer. It is Blue Cross and Blue Shield of South Carolina.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, we will, and I'm sure I do.
[AGENT][NEUTRAL] But, but I don't have, yes, ma'am. I don't have any detailed information on the, for his Blue Cross. Now, ma'am, you would have to reach out um to him to get that information, [PII].
[CUSTOMER][NEUTRAL] I didn't know if she had a member ID.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, OK.
[CUSTOMER][POSITIVE] OK, we can definitely do that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, well, um, and then one last thing once that we have received and processed the claim, we also have a portal that you can check claim status and get the EOB for APL from and that website that you would go to to set that up is secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Cool, I will notate that and if we need to we can go there. It looks like we first need to get this other insurance. OK, any reference number for my call?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh,
[AGENT][POSITIVE] Sure, you would actually use my name along with today's date.
[CUSTOMER][POSITIVE] Perfect that was [PII], right?
[AGENT][NEUTRAL] Yes, ma'am, uh-huh.
[CUSTOMER][POSITIVE] Perfect alright thank you so much.
[AGENT][POSITIVE] OK. Well, you are very welcome and thank you again for calling APL and I hope you have a wonderful afternoon.
[CUSTOMER][POSITIVE] You as well thank you.
[AGENT][POSITIVE] Yes, ma'am. Thank you.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye-bye.