AccountId: 011433970860
ContactId: 7f9d1987-0572-493f-9cae-3ae335193750
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 385079 ms
Total Talk Time (AGENT): 144174 ms
Total Talk Time (CUSTOMER): 154595 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/7f9d1987-0572-493f-9cae-3ae335193750_20250314T14:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, um, this is [PII] at Century Health Solutions calling on behalf of Delray Medical Center.
[CUSTOMER][NEUTRAL] On a recorded line.
[CUSTOMER][NEUTRAL] Um, and I'm trying to verify, um.
[CUSTOMER][NEUTRAL] Open bodily injury claim for a patient of ours. I have a claim number um but I'm not sure, um, I'm not sure if it's, you know, the right claim or anything like that.
[AGENT][NEUTRAL] OK. All right, Ms. [PII], I can help you with the claim. Uh, can you please give me your callback number first just in case our call is disconnected?
[AGENT][NEUTRAL] I can call you back.
[CUSTOMER][NEUTRAL] Yes ma'am um
[CUSTOMER][NEUTRAL] Yes ma'am, that is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 329 4.
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Um, the patient's name, I'll spell it, um, but I have a question. Do y'all do, do y'all handle like injury claims or is it just strictly like accident claims that that provide payment to the patient?
[AGENT][NEUTRAL] It's accident claims that provide payment um based on the policy certificate.
[CUSTOMER][NEUTRAL] OK, so if the patient was injured in an automobile accident, um.
[CUSTOMER][NEUTRAL] Could that, could this client cover their medical bills?
[AGENT][NEUTRAL] Uh, it depends on how the policy is written, um, for the accident, they would, you know, have to actually file the claim and then we'd have to see the diagnosis and procedure code and have a claim examiner examine the claim and process it. But if it was an accident, then and they have accident insurance, then definitely they should file a claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, so I'm sorry I said auto accident but this was a fall um I'll go ahead and give you the patient's name just so you can pull up the claim. I don't have a policy number but I have a claim number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and what's their name and date of birth?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The name is I'll spell the first, well I'll spell the first and last name I can't pronounce it um the first name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the last name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And then what is the insured's date of birth?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, I'm not sure if he's the insured, um, but his date of birth is [PII].
[AGENT][NEUTRAL] OK. And then what is that claim number, please?
[CUSTOMER][NEUTRAL] I'm sorry, what was that?
[AGENT][NEUTRAL] The claim number?
[CUSTOMER][NEUTRAL] Um, that is 142.
[CUSTOMER][NEUTRAL] 0381 M like
[CUSTOMER][NEUTRAL] Mar Mary L like Lima.
[CUSTOMER][NEUTRAL] 7
[AGENT][NEUTRAL] OK. That is
[AGENT][NEUTRAL] your policy number, so let me go ahead and look that up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and then what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Um, the date of service we have is [PII].
[CUSTOMER][NEUTRAL] And the charges were 3.
[CUSTOMER][NEUTRAL] 10384.
[AGENT][NEUTRAL] OK, and then what was the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, we've not had any payments on this.
[AGENT][NEUTRAL] OK, alright, let me look and see they've got.
[AGENT][NEUTRAL] OK, this policy that they have.
[AGENT][NEUTRAL] Is a Medlink policy and this is just to verify benefits. It's not a guarantee of payment. This Medlink policy is a supplemental insurance policy that's billed secondary to their primary, and it helps with deductible, co-pay and co-insurance.
[AGENT][NEUTRAL] So I'm gonna look up that date for the claim and see if we've had anything turned in.
[AGENT][NEUTRAL] For that data service.
[CUSTOMER][NEUTRAL] OK, do you have a, do you have a claim number?
[AGENT][NEUTRAL] Yeah, if it's been.
[CUSTOMER][NEUTRAL] That you can give me?
[AGENT][NEUTRAL] If it's been submitted I'll be able to give you one if it hasn't been submitted then.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Don't have one.
[AGENT][NEUTRAL] OK, I do not show that anything has been sent in for.
[AGENT][NEUTRAL] The service of [PII].
[AGENT][NEUTRAL] Or box.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So there's not any claims open.
[CUSTOMER][NEUTRAL] Under this policy for him.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, I'm not seeing any open claims for him.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] OK, all right, thank you so much.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, you're so welcome. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] No ma'am I think that's it.
[AGENT][POSITIVE] OK, Miss [PII], I hope you have a wonderful weekend and thank you for calling APL.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, ma'am bye bye.