AccountId: 011433970860
ContactId: 489bf0ba-6b1e-453b-bf81-c6eb120aaf57
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 467820 ms
Total Talk Time (AGENT): 146717 ms
Total Talk Time (CUSTOMER): 136692 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/489bf0ba-6b1e-453b-bf81-c6eb120aaf57_20250423T16:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, my name is [PII], and I'm calling from Nicola Children's Hospital. I want to know the claim status of this member.
[AGENT][NEUTRAL] Sure, I can check on a claim for you. [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, I do have the policy number.
[CUSTOMER][NEUTRAL] The policy number is
[CUSTOMER][NEUTRAL] 01912758 M Mary L Lima 8.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Uh, the member's name is [PII]. And date of [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] The date of service was on [PII].
[AGENT][NEUTRAL] OK, do you have that bill amount?
[CUSTOMER][NEUTRAL] The bill amount is $1,313.49.
[AGENT][POSITIVE] OK, got it. Thank you. One moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], I'm sorry, could you, uh, what was the uh tax ID for this, uh, provider, please?
[CUSTOMER][NEUTRAL] Tax ID number is [PII].
[AGENT][POSITIVE] OK, thank you for that. I do believe I've found it. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, OK, so we did receive this claim, uh, looks like we're missing a copy of the primary EOB.
[CUSTOMER][NEUTRAL] Uh, yes, as per the previous conversation.
[CUSTOMER][NEUTRAL] Uh, this one.
[CUSTOMER][NEUTRAL] We have sent a medical records to the mailing address, [PII], OK [PII]. So I want to know the updated status of the medical records.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure. Um, was that remaining amount after major medical paid, was that $65.92?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK awesome. OK, so I apologize for that confusion. So yes, we did receive that information, um, and we did pay that benefit of $65.92. If you'll give me one moment, I'll get that, uh, check information for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need this claim number first?
[CUSTOMER][POSITIVE] Yes, no problem.
[AGENT][NEUTRAL] OK, the claim number is 3,559,630.
[AGENT][NEUTRAL] And then I've got that check number when you're ready.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK, I'm ready for it.
[AGENT][NEUTRAL] OK, that is 20.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, 202-6021.
[CUSTOMER][NEUTRAL] When was the issue?
[AGENT][NEUTRAL] Uh, this check was issued [PII], and I'm showing it clear [PII].
[CUSTOMER][NEUTRAL] Uh, do you have the payment details for this one? How, what is the allowed amount and how much it's paid?
[AGENT][NEUTRAL] Yes, we paid that full benefit amount of $65.92.
[CUSTOMER][NEUTRAL] And what is the bulk amount?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, what is the bulk amount, the bulk?
[AGENT][NEUTRAL] We just we paid that one benefit of $65.92. The total allowance for outpatient is $500 per calendar day.
[CUSTOMER][NEUTRAL] Can you send me an EOB for this one?
[AGENT][NEUTRAL] Sure, what was that fax number for you?
[CUSTOMER][NEUTRAL] Fax number is [PII].
[AGENT][NEUTRAL] OK, I'm gonna read that back to you to make sure I heard that correctly. That was 513-9645675?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, I will go ahead and get that sent now. Uh, should get it within about 10 minutes or so. Was there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] And what about the medical records that we uh send? Have you, I want to know the updated status of the medical records.
[AGENT][NEUTRAL] That is what this is. After receiving that information, we were able to pay this benefit of $65.92.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[CUSTOMER][NEUTRAL] OK, and uh can you please spell out your name one more time for me?
[AGENT][NEUTRAL] Sure, it's [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what would be the call reference number for this one?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh, so my last initial is [PII]
[CUSTOMER][POSITIVE] OK, thank you, [PII], for the information and thank you for, OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Of course, was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Uh, just give me an, uh, just let me, just give me a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] All right, well thanks for giving us a call. Yeah, have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you. Thank you, [PII], for the information.
[CUSTOMER][NEUTRAL] Yes.