AccountId: 011433970860
ContactId: 671c9037-0e8a-4c38-9913-cd67105a561c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 868440 ms
Total Talk Time (AGENT): 399517 ms
Total Talk Time (CUSTOMER): 185725 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/671c9037-0e8a-4c38-9913-cd67105a561c_20250610T16:34_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] with Covenant Medical Group.
[AGENT][POSITIVE] Yes, how can I help you, [PII]?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Claim status for this.
[CUSTOMER][NEUTRAL] What's she got? She's got 6 claims.
[AGENT][NEUTRAL] OK, well, let's, uh, what is the policy number so we can start looking at that?
[CUSTOMER][NEUTRAL] 02552172.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Um, [PII], date of birth is [PII].
[AGENT][POSITIVE] Thank you. And what is the good callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Uh, direct dial is [PII].
[AGENT][NEUTRAL] OK. Thank you. Um, [PII], you said that you had several plans to look at. What's the date the date of service for the first one?
[CUSTOMER][NEUTRAL] Um, [PII] for the amount of 394.
[AGENT][NEUTRAL] 394.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so it looks like the claim number on this one.
[AGENT][NEUTRAL] It's 359.
[AGENT][NEUTRAL] 4379.
[AGENT][NEUTRAL] And it looks like we received that uh saying.
[AGENT][NEUTRAL] Sorry, just got a lot of claims here.
[CUSTOMER][NEUTRAL] Yeah, I've got 6 of them, so.
[AGENT][NEUTRAL] Yes, it looks like you received the claim on [PII].
[AGENT][NEUTRAL] And we processed it on [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] 225
[AGENT][NEUTRAL] Now, this uh particular claim was denied, and the reason it was denied is that the policy doesn't provide benefits.
[AGENT][NEUTRAL] For inpatient hospital service.
[AGENT][NEUTRAL] It for by a doctor, so there are no benefits for charges made by a doctor for inpatient visits.
[AGENT][NEUTRAL] And that looks like that's what this is built.
[CUSTOMER][NEGATIVE] Well then all 6 of these are gonna be, yeah, all 6 of these are gonna be denied because I work for the doctors. I don't work for the hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, there are, there are several of them that have the same uh code on them that uh you would like, we can certainly look them up and then we can go through them.
[AGENT][NEUTRAL] Uh, you said that uh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] If you want to, we can look at, uh, maybe one or two more. We can look up all of them, um, so what is the next state of service that we have for, uh, for Jo?
[CUSTOMER][NEUTRAL] Well, let's see if we
[CUSTOMER][NEUTRAL] They're kind of mixed up. The next one is [PII] for the amount of 527.
[CUSTOMER][NEUTRAL] How do I get a copy of all these EOBs?
[AGENT][NEUTRAL] Uh, I can certainly send you that. Um, I, uh, there's no problem with that. I can certainly send you that. Your claim on this one is uh 3603633. So that is um 35, excuse me, I'm sorry, 36.
[AGENT][NEUTRAL] 03633. Again, it, it looks like this is all denied because of that same uh being in the uh a a doctor visit with an inpatient um visit.
[CUSTOMER][NEUTRAL] Yeah, she had.
[AGENT][NEUTRAL] So if you like I can I can fax this to you that would be helpful.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] So all 6 of these are gonna be denied.
[AGENT][NEUTRAL] Would you like
[CUSTOMER][NEUTRAL] OK. Yeah, cause all these have to do with our pregnancy.
[AGENT][NEUTRAL] Oh, I see. OK. Um, well, let me, uh, now the EOB should be coming to you, um, but, uh, um, if you haven't received them, then I'll be glad to fax you copy and that will show that the, uh, doctor's visits for an in-hospital stay will not be covered.
[CUSTOMER][NEUTRAL] Do y'all have a portal?
[AGENT][NEUTRAL] We do, um, our website is [PII].
[AGENT][NEUTRAL] Right, [PII].
[AGENT][NEUTRAL] [PII]. So that's [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you have, do you have the insured's uh um account number?
[AGENT][NEUTRAL] Because you will need that.
[CUSTOMER][NEUTRAL] Yeah, I have her account number.
[AGENT][POSITIVE] Awesome. OK. Well then, uh, [PII], you can certainly go into our online service center and, uh, it will show all those records that you'll need, uh, in order, it will show all the EOBs, um, and it will show, uh, what they were denied for.
[AGENT][NEUTRAL] And uh so if you wanted to do that, um, you'll also show uh what her benefits are or you might be able to find that as well, uh at least uh to see what is not covered, um, but, uh, that will all be on the website at um [PII] or [PII]. It's gonna get you to the same place no matter what. You'll just have to build a record, um, that will be a username and a password, and you'll need the account number.
[AGENT][NEUTRAL] Um, and then we're fine. You just be able to find all those records and uh have the EODs right there.
[CUSTOMER][NEGATIVE] OK, I just put in the tax ID for us which is the [PII] and it's coming up as error.
[CUSTOMER][NEUTRAL] The user was found with this information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, are you, are you signing in as a new user?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh
[AGENT][NEUTRAL] Another there so you know.
[CUSTOMER][POSITIVE] Great
[CUSTOMER][POSITIVE] Great your OC account.
[AGENT][NEUTRAL] Yes, you'll have to start all over again, um, and, uh, um, what they did was they, they changed their accounts or they changed their online service center completely. So if you had an account with us before, uh, it would mean that you'll have to go into the site and, and, uh, create a new account. Um, it's usually what happens whenever, whenever they revamp them like this sometimes that can happen, so you would need to go in uh as a new user and create a whole new account.
[CUSTOMER][NEUTRAL] I I do have APL. Hold on.
[AGENT][NEUTRAL] Otherwise,
[CUSTOMER][NEUTRAL] I have 4 pages of.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alternatively, if you would like, uh, you can give me another date of service so I can see, uh, you know, if you've got it or not.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I think I do have your portal hold on.
[CUSTOMER][NEUTRAL] Yeah, I created a
[CUSTOMER][NEUTRAL] Log in, hold on, let's see.
[CUSTOMER][NEUTRAL] Click on log in.
[CUSTOMER][NEUTRAL] Just that
[AGENT][NEUTRAL] So this is a new, this is a new uh login that you're creating, right? Because the old one won't work.
[AGENT][NEUTRAL] Is it coming up anything? If anything happens or?
[CUSTOMER][NEUTRAL] Hold one second.
[CUSTOMER][NEUTRAL] I get rid of my cat walked.
[CUSTOMER][POSITIVE] I like my Calo. It makes life easier.
[CUSTOMER][NEGATIVE] It says it doesn't recognize the email account.
[CUSTOMER][NEUTRAL] See if I can do the user name.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you're using the same
[CUSTOMER][NEGATIVE] So did y'all get a new portal that why it's giving me these issues?
[AGENT][NEUTRAL] Yes, that's what that's what I was saying is that, is that what we did is we updated the portal um to uh to an all new, uh, an all new site and, uh, you would need to, uh.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] We log in with a with a brand new um account uh a brand new uh username and password.
[AGENT][NEUTRAL] So is that where you're at right now is using the old one or you're using a new uh using?
[CUSTOMER][NEUTRAL] Uh, right now.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OG
[CUSTOMER][POSITIVE] It's gonna send me a verification code. Oh, that's nice.
[AGENT][NEUTRAL] OK, so it's sending you a verification code.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What does it show on your screen?
[CUSTOMER][NEUTRAL] Uh, verification code has been sent to your email.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] There it is, showed up.
[AGENT][NEUTRAL] Then you'll need to go back to your email and, and, and do that. We have to verify that uh for each new account.
[AGENT][NEUTRAL] Um, and then you will go into the, uh, online service center and create uh a new account with a new user, a new password, um, and then you'll be able to find, uh, all of Joey's, uh.
[AGENT][POSITIVE] Yes using her.
[AGENT][NEUTRAL] Patient accountant
[CUSTOMER][NEGATIVE] Yeah it keeps on giving me the same error.
[CUSTOMER][POSITIVE] That's interesting.
[AGENT][NEUTRAL] And what is it saying?
[CUSTOMER][NEUTRAL] Uh, tax ID is not found.
[CUSTOMER][NEUTRAL] The users were found with the information that was entered.
[CUSTOMER][NEGATIVE] Please try again if you keep on persistently getting this error contact customer service do option 4.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, let me see what we have here.
[AGENT][NEUTRAL] Let me look at the, at the time that we have.
[CUSTOMER][NEUTRAL] But it sent me the verification code so that's weird.
[AGENT][NEUTRAL] Yes, it will get that far. That's, uh.
[AGENT][NEUTRAL] So what it's doing is it's saying it doesn't show uh that you uh that [PII] has sent us a probably it might be a W9.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so we don't have a W-9 on form on file. We would need that.
[AGENT][NEUTRAL] Um, to verify the tax ID.
[AGENT][NEUTRAL] So, uh, I can give you my fax number or.
[AGENT][NEUTRAL] I think it would actually be faster if you could fax it rather than mailing it, um, but that's why it's not showing your your.
[AGENT][NEUTRAL] Remember because we haven't verified your your tax ID.
[CUSTOMER][NEUTRAL] OK, what's the fax number then?
[AGENT][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And if you could send us that.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, ma'am. [PII], so it's [PII].
[AGENT][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And once we have that uh verified, then then you'll be able to use that tax ID number.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] You'll be able to go in and and create that account and everything that is uh that is listed would be every every claim that is is listed should be on there uh for your um.
[AGENT][NEUTRAL] For that hospital visit.
[AGENT][NEUTRAL] So you said that there were about 5 or 6 more of them than uh it should all be on there, but it looks like for that and.
[CUSTOMER][NEUTRAL] Yeah, they are.
[CUSTOMER][NEGATIVE] Yeah, they're all gonna be denied because they're all for.
[CUSTOMER][NEUTRAL] Going in for the baby, so they're all doctor visits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else that I can help with?
[CUSTOMER][NEUTRAL] OK, well let me.
[CUSTOMER][NEUTRAL] No, let me fax over the W-9 and then I'll get back into the portal later once they tell me everything's good to go.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Well, there's nothing else I can help with, and thank you for contacting AT. I have a very good day.