AccountId: 011433970860
ContactId: 69ea71d2-f751-4506-ab0e-f5a5ef8e049a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 843000 ms
Total Talk Time (AGENT): 215497 ms
Total Talk Time (CUSTOMER): 260502 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/69ea71d2-f751-4506-ab0e-f5a5ef8e049a_20250320T17:24_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is Easy. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and I'm calling from Baptist Health Medical Group Orthopedics. Good afternoon to you.
[AGENT][POSITIVE] Good afternoon.
[CUSTOMER][NEUTRAL] Uh, thank you. I'm calling about a claim that I actually submitted some information via email, but I haven't heard anything back.
[AGENT][NEUTRAL] OK, sure, I said, I can assist you with um claim status. First, let me get a callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII], no extension.
[AGENT][NEUTRAL] OK, now I need the member's policy number, please.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 021.
[CUSTOMER][NEUTRAL] 168
[CUSTOMER][NEUTRAL] 28 M like Mary L like Lima 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And thank you. And what's the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] [PII], that's [PII] $4,0037.
[AGENT][NEUTRAL] OK. One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and again, you said that was for [PII] for $4,0037?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, yes, ma'am. I'm showing that we received that claim on [PII] and it paid on [PII]. It paid out for $765.18.
[AGENT][NEUTRAL] But are you saying that you, oh, OK.
[CUSTOMER][POSITIVE] Awesome.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, can I go ahead and get information on that payment, please?
[AGENT][NEUTRAL] Um, yes, ma'am. It was a single check for $765.18.
[AGENT][NEUTRAL] The check number is 2030568.
[AGENT][NEUTRAL] And it was mailed to the address on the claim, which is um Baptist Health Medical Group Orthopedics, [PII].
[AGENT][NEUTRAL] Um, and it was
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Mailed out on [PII] and I'm showing that it's still outstanding.
[CUSTOMER][POSITIVE] OK. Wonderful. Um, now, may I have that claim number, please?
[AGENT][NEUTRAL] Yes, the claim number is 3569784.
[CUSTOMER][NEUTRAL] OK, now I do have others that I'm calling about. Would it be one reference number for everything or just your name and today's date?
[AGENT][NEUTRAL] Yes, it'd be one reference number for um all claims and the reference number is my name and today's date.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] All right. Wonderful. Well, let me know when you're ready and I'll give you the second claim.
[AGENT][NEUTRAL] OK, is it for the same member?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thanks for your patience. I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] OK, that would be.
[CUSTOMER][NEUTRAL] 246-521-6
[CUSTOMER][NEUTRAL] M Mary, L [PII] 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] OK, thank you. Now, I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] $6,842 even.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. And could I get that date of service one more time, please?
[CUSTOMER][NEUTRAL] Sure. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what are the bill charges again?
[CUSTOMER][NEUTRAL] Uh, that was for.
[CUSTOMER][NEUTRAL] $6,842 even.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] This system is so slow today.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, are these for the hospital charges?
[CUSTOMER][NEUTRAL] No. These would be for the physician.
[AGENT][NEUTRAL] So I'm showing claims with that date of service but not with those bill charges.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] There's one for anesthesia.
[CUSTOMER][NEUTRAL] So if, if I
[CUSTOMER][NEUTRAL] If if I understand correctly, this is a gap plan, right? Normally the primary send forwards it over.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Like the adjudication.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Right, I.
[CUSTOMER][NEUTRAL] OK. Um, so,
[CUSTOMER][NEUTRAL] Yeah, I'm sorry, go ahead.
[AGENT][NEUTRAL] I was sending along with the EOB from the primary insurance, but go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] No, that's OK. So basically it looks like you don't, it wasn't forwarded over. What do you do in this case?
[AGENT][NEUTRAL] Well, you can always submit it as long as uh um the member had coverage on the date of service will receive the claim. There's no timely filing limit and get it processed.
[CUSTOMER][NEUTRAL] OK. Uh, I have used, uh, the claims at [PII].
[CUSTOMER][NEUTRAL] Before is that still a good email?
[AGENT][NEUTRAL] No, ma'am. We can't um receive claims via email anymore because of the HIPAA, but we can receive them via fax. We have a pair ID also, or of course, they can be mailed in.
[CUSTOMER][NEUTRAL] Yeah, unfortunately we're not set up for electric uh on this uh on this company uh payer, but I'll take that fax number please.
[AGENT][NEUTRAL] OK. The fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] and please attention it to the claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK dokey. Thank you.
[AGENT][POSITIVE] Mhm. No problem.
[CUSTOMER][NEUTRAL] All right, so then
[CUSTOMER][NEUTRAL] I do have 2 more for you if you can help me.
[AGENT][NEUTRAL] Yes, ma'am. I can assist you. Um, are they for the same member, different members?
[CUSTOMER][NEUTRAL] No, different members.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][POSITIVE] OK, I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] All right, this one is I'm back.
[CUSTOMER][NEUTRAL] Interesting. It just has 00971922.
[AGENT][NEUTRAL] OK, and someone actually came up. Um, please [PII]fy the name and date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um [PII] and [PII].
[AGENT][NEUTRAL] OK. Yeah, here he is. One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and the date of service and bill charges on the claim, please.
[CUSTOMER][NEUTRAL] This is an oldie. [PII].
[CUSTOMER][NEUTRAL] Total charge is $9,563 even.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, I'm not showing a claim on file for that date of service and bill charges either.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I will go ahead and send that one as well.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] With the EU primary EOD.
[CUSTOMER][NEUTRAL] All right, that's.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm ready for the policy number.
[CUSTOMER][NEUTRAL] All right, this one is.
[CUSTOMER][NEUTRAL] 01455852
[AGENT][NEUTRAL] OK. Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, and the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] $1,307.
[AGENT][NEUTRAL] OK, I'm not showing this claim on file either.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Just to confirm that fax number is [PII].
[AGENT][NEUTRAL] Right, and be sure to attention it to the claims department.
[CUSTOMER][NEUTRAL] Attention claims department OK all right well um I'm sorry I did not get your name at the start of the call.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Um, it's [PII]. Um, it's spelled [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] OK. Well, thank you so much. I really appreciate your help.
[AGENT][POSITIVE] No problem, [PII]. Thank you for calling ATL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] Same to you. Bye-bye