AccountId: 011433970860
ContactId: 440d9b50-7e21-4331-b86b-4ac49f4250fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 557719 ms
Total Talk Time (AGENT): 224649 ms
Total Talk Time (CUSTOMER): 132041 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/440d9b50-7e21-4331-b86b-4ac49f4250fc_20250623T15:19_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] Like
[AGENT][POSITIVE] Good morning. Thanks for calling EPL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi, my name is [PII]. I'm calling from Prisma Health, and I have a question regarding a claim.
[AGENT][NEUTRAL] OK, so you have a question regarding a claim, is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that and I'm, could you please spell your first name for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Oh, I'm sorry, [PII]. I don't know what I heard, but I did not hear that. Thank you. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] Um, it is.
[CUSTOMER][NEUTRAL] 02351181
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And to be any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Data services [PII] [PII].
[CUSTOMER][NEUTRAL] Total bills amount is $4,225.
[AGENT][NEUTRAL] I'm sorry, you said 421. I'm sorry. Let me start over again. 1021, 24 to 1022 24. Is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] And filled them out with $4,225.
[CUSTOMER][POSITIVE] That is correct.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, give me just a moment to look at some additional information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so I do show that that do you already have the claim number, [PII], or do you need that?
[CUSTOMER][NEUTRAL] I do. I'm just um.
[CUSTOMER][NEUTRAL] I'm looking at the card and I see that it.
[CUSTOMER][NEUTRAL] I guess a limited plan.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] We have an electronic EOB, but it doesn't show any patient responsibility. I don't think that's correct, so that's what I'm asking.
[AGENT][NEUTRAL] OK. Well, so first off, we do not determine since we're not a major medical carrier and this is a limited benefit plan, we, APL does not determine patient responsibility. That would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you said that you do have the claim number. Is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, um, it ends in 2629.
[AGENT][NEUTRAL] Um, no, ma'am, not for this data service. The claim number is 3531442.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, yeah, that's totally different than what I have. Please give me the information you have.
[AGENT][NEUTRAL] Mm, OK. So that claim number again is 3531442.
[AGENT][NEUTRAL] And it was denied [PII], the, the remark on the denial states that our records indicate.
[AGENT][NEUTRAL] That premium for this service date dates was not received, therefore benefits are not payable.
[CUSTOMER][NEUTRAL] OK, is there any way you can give me, uh, provide a copy of the EOB?
[AGENT][NEUTRAL] I can, and I'm also gonna give you a website that you should be able to print it from, but sometimes with this policy, this type of policy, it is a little more difficult to print it, but with the with the claim number, you should be able to, and just for future reference, that website is secured.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] So give me just a moment and let me pull.
[CUSTOMER][NEUTRAL] Yeah, I was
[AGENT][NEUTRAL] Uh-huh, go ahead. I'm sorry. I don't mean to.
[CUSTOMER][NEUTRAL] I was trying to access that.
[CUSTOMER][NEUTRAL] No, I was trying to access that and um like I have a spreadsheet of like different insurance companies and my logins and that kind of thing and so when I put it in it didn't populate so then.
[CUSTOMER][NEGATIVE] I went and tried to create an account with my tax ID and it gives me an error message.
[AGENT][NEUTRAL] OK, so let me
[CUSTOMER][NEUTRAL] So I don't know.
[AGENT][NEUTRAL] What is, um, give me just a second.
[AGENT][NEUTRAL] What's the tax ID number you're using?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so that is, that is correct. And then um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I mean, that is what we're showing. Like I said, on this for some reason, sometimes these.
[AGENT][NEUTRAL] Do not pull up because of this type of plan, but I will be happy to send it to you, so give me just a second, but you, that is the correct, we do have that on file.
[CUSTOMER][POSITIVE] Alright, OK, great.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It just takes a minute to pull this up. Well, the facts need to be put to your attention, [PII]?
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Now
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, when you need from the grocery store to go.
[AGENT][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Why?
[AGENT][NEUTRAL] OK, and what is a good fax number uh for you please?
[CUSTOMER][NEUTRAL] Uh, the fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and I am just gonna repeat this back to make sure I heard it correctly. [PII].
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, [PII], so I have just sent that to you so provided there's not any type of technical mishap, you should be receiving that very soon.
[CUSTOMER][POSITIVE] OK, I appreciate that and I'm sorry, what's your name again?
[AGENT][NEUTRAL] Again, my name is [PII], and my name along with today's date will be your call reference number.
[CUSTOMER][POSITIVE] All right, I appreciate that so much.
[AGENT][POSITIVE] OK, well, you are certainly very welcome. So is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's, that's it. Thank you. Have a wonderful week.
[AGENT][POSITIVE] OK. Well, you're, oh, yes, ma'am. I hope you have a wonderful week too, and thank you again for calling ATL.
[CUSTOMER][POSITIVE] All right thank you bye bye.
[AGENT][POSITIVE] All right, you're welcome. Bye bye.