AccountId: 011433970860
ContactId: 5ab164f3-a74f-48fd-9c0e-64e61df3afd1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 411609 ms
Total Talk Time (AGENT): 173510 ms
Total Talk Time (CUSTOMER): 69620 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/5ab164f3-a74f-48fd-9c0e-64e61df3afd1_20250424T16:02_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is. How may I assist you?
[CUSTOMER][NEUTRAL] I'm sorry, what was your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK, hi, so I'm calling to check claim status.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Sure, I can assist you with claim status.
[AGENT][NEUTRAL] And may I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have a contact number just in case we get disconnected, Ms. [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And may I have the name of the facility you're calling from from my location?
[CUSTOMER][NEUTRAL] South Georgia Medical Center.
[AGENT][NEUTRAL] OK. Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Policy number is.
[CUSTOMER][NEUTRAL] 023-37055
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] OK, perfect. Thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII]. The amount is $1,276.
[AGENT][NEUTRAL] OK. Let me see if I can find this claim, and that was [PII], correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] All right. OK.
[AGENT][NEUTRAL] OK, let me call this EOB for future, you can check claim status online through our website at [PII] and that's just optional. And it's gonna be a minute. I'm waiting on the ELB, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. It looks like we processed this claim on [PII].
[AGENT][NEGATIVE] And see, it looks like it was denied. The reason for the denial is that benefits are payable only if major medical insurance provide benefits.
[CUSTOMER][NEUTRAL] OK, it was denied due to what now?
[AGENT][NEUTRAL] Um, benefits are payable only if major medical insurance provides benefits.
[AGENT][NEUTRAL] So it has to be approved and applied towards the deductible co-payment and co-insurance for us to consider. This is a secondary policy to the major medical.
[CUSTOMER][NEUTRAL] OK, hold on, let me see what, hold on one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You said it has to be it has to be applied to the patients of that before you guys can cover it. You said it can't be applied.
[AGENT][NEUTRAL] Yeah, it has
[AGENT][NEUTRAL] It has to be applied towards the deductible, co-payment or co-insurance for us to consider, um.
[CUSTOMER][NEUTRAL] It was.
[AGENT][NEUTRAL] OK, let me see, let me look at the paperwork one more time and make sure that we are not miss looking that information. Um, let me look at the papers, one moment.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, um,
[AGENT][NEUTRAL] OK, so I'm not sure exactly what happened, but when it came in, it came in in top of a UB form.
[AGENT][NEUTRAL] It, it didn't come in as an explanation of benefits. So um it has some recent codes, but it doesn't have the definition of the recent codes because it was like.
[AGENT][NEUTRAL] Print print out on a UBO4 form for some reason. It came in really weird. I don't know if if it's uh the way that it faxed over to us or we don't know what happened, but yeah, we just need that explanation of benefits to send us to it to us again.
[CUSTOMER][NEUTRAL] OK, yes, I will get that over in one second, uh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, is the claim number still 34,614,080?
[AGENT][NEUTRAL] I'm sorry, what is that number that you're giving me?
[CUSTOMER][NEUTRAL] The claim number is it still the same?
[CUSTOMER][NEUTRAL] 3,461,480
[AGENT][NEUTRAL] No, that's not the claim number I'm looking at. The claim number is 3565522.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And what's the fax number to um mail that I mean email that or fax it goodness.
[AGENT][NEUTRAL] It's OK. You can fax it to [PII].
[CUSTOMER][NEUTRAL] OK, alright, and attention it to so or just uh claims department?
[AGENT][NEUTRAL] Just claims department, it goes to claims department, yeah, we don't see it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yes ma'am.
[CUSTOMER][POSITIVE] I will get that faxed over thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Yeah, OK, thank you for calling ATO. Have a good day. Bye-bye, Miss [PII].
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.