AccountId: 011433970860
ContactId: 24d652cc-6f19-48d5-8c07-ddc71ff66738
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 379579 ms
Total Talk Time (AGENT): 147806 ms
Total Talk Time (CUSTOMER): 99901 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.5, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/24d652cc-6f19-48d5-8c07-ddc71ff66738_20250319T17:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm with UC Davis Medical Center and I'm calling to get status of a claim.
[AGENT][NEUTRAL] All right, [PII], I'm happy to check on claim status today. What's the patient's policy number?
[CUSTOMER][NEUTRAL] 02471754.
[AGENT][POSITIVE] Alright thank you one moment.
[AGENT][NEUTRAL] And if I can get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, [PII] [PII].
[AGENT][NEUTRAL] Alright, thank you for that and then what's the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the build out?
[CUSTOMER][NEUTRAL] $48,932.26. I do have the claim number already. Um, it looks like you guys were waiting for information from the employer association to confirm eligibility.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, what's that claim number, [PII]?
[CUSTOMER][NEUTRAL] 356-22202.
[AGENT][NEGATIVE] Right, it looks like unfortunately the status on it carry hasn't changed.
[AGENT][NEUTRAL] Um, the policy paid to date shows to.
[CUSTOMER][NEUTRAL] I'm sorry, your phone I'm sorry, hold on, your phone cut out. What was that?
[AGENT][NEUTRAL] So it looks like the status on the claim hasn't changed at this time. It looks like the patient's effective date was [PII]. It looks like the coverage terminated on that date.
[CUSTOMER][NEUTRAL] On [PII], you said [PII]?
[AGENT][NEUTRAL] Yeah, that's the last paid to date that I show, yes.
[CUSTOMER][NEUTRAL] OK, did you, OK, so when you guys state um you're awaiting information from the employer association, when was the last time you contacted them?
[AGENT][NEUTRAL] Um, it looks like last communication sent out was on [PII].
[CUSTOMER][NEUTRAL] And that was to whom?
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Uh, the group is Business Workers of America.
[CUSTOMER][NEUTRAL] And then how long do you usually allow them to update?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I mean, at this point, I feel like we should have gotten something back. Let me see if I see anything else in here.
[AGENT][NEUTRAL] for this claim different one.
[AGENT][NEGATIVE] Yeah, I mean, I feel like Ky at this point they should have responded back because I double checked to see if it returned like it was unable to deliver anything like that um usually it takes like 5 to 7, you know, they will return it back via fax or whatever so.
[AGENT][NEGATIVE] I don't show any returned mail like they didn't receive it so we just haven't received correspondence back.
[CUSTOMER][NEUTRAL] OK, um, are you gonna contact them again or what's the, like what's your guys' usually like follow up?
[AGENT][NEUTRAL] Um, yeah, I mean, I don't know this is an individually funded plan through the Business Workers of America, so I don't know that they'll send any more communication regarding the claim at this point.
[CUSTOMER][NEUTRAL] OK, what is the business, what group, what is it? Business Workers of America. What's your phone number?
[AGENT][NEUTRAL] What's their phone number? Let's see.
[AGENT][NEUTRAL] So their contact number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And if you'd like [PII], I can transfer you to them.
[CUSTOMER][NEUTRAL] OK, and then also do you guys mail out um the denial to the patient?
[AGENT][NEUTRAL] Mhm. Yeah, it would have been sent out to the patient. If you need a copy of it, we can also fax you a copy if you guys don't have it.
[CUSTOMER][NEUTRAL] Um, no, I have a copy. I was just saying about the patient.
[AGENT][NEUTRAL] Yes, ma'am. Yeah, they would be notified.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, can I have a call reference number before you transfer me?
[AGENT][NEUTRAL] Absolutely. Call reference is my name with my last initials in today's date. My name again is [PII], that's [PII] Last initial is [PII].
[CUSTOMER][POSITIVE] OK great thank you so much.
[AGENT][NEUTRAL] You're welcome. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Are recorded for quality assurance. Our hours of operation are Monday through.