AccountId: 011433970860
ContactId: 9de3bf3b-cc0e-447c-a5bd-949ef06bf6b2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 642640 ms
Total Talk Time (AGENT): 147197 ms
Total Talk Time (CUSTOMER): 125856 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/9de3bf3b-cc0e-447c-a5bd-949ef06bf6b2_20250611T13:28_UTC.wav
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[AGENT][NEUTRAL] This is [PII] with ATL. How can I help you?
[CUSTOMER][NEUTRAL] Sure, what was your name? I'm sorry?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi, um, my name is [PII], and I'm calling from a provider's office. I'm calling regarding a patient's claim. I have a few specific questions regarding the claim.
[AGENT][NEUTRAL] OK, I can help you with claim status [PII]. Can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Um, I'm hoping this is, it is D42031652.
[AGENT][NEUTRAL] Is there anything on the card that says a policy certificate number?
[CUSTOMER][NEUTRAL] Um, to be quite honest, the patient did not provide a card.
[AGENT][NEUTRAL] OK, um, I can look them up by last name. Give me just a moment.
[CUSTOMER][POSITIVE] Sure thank you.
[AGENT][NEUTRAL] Right, and what is their last name?
[CUSTOMER][NEUTRAL] It's spelled [PII]. [PII]. I think that's how you pronounce it.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] Oh, OK, OK, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] What is the first name?
[CUSTOMER][NEUTRAL] It's going to be [PII].
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][NEUTRAL] I do apologize my computer is going just a little slow, so one moment.
[CUSTOMER][POSITIVE] No, take your time thank you.
[AGENT][NEUTRAL] Do you have her social?
[CUSTOMER][NEUTRAL] Oh, let's see if she provided her social?
[CUSTOMER][NEGATIVE] No, she did not.
[AGENT][NEUTRAL] Oh, that's OK.
[CUSTOMER][NEUTRAL] I have a claim number. I don't know if that's helpful.
[AGENT][NEUTRAL] Um, let me see if I can pull her up first.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEGATIVE] My system's going just a little slow.
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] All right, let's try it differently.
[AGENT][NEUTRAL] My system is acting up, so let me see if I can try something else.
[AGENT][NEUTRAL] Here we go. And you said it's [PII]?
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] And what is her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And what kind of um claim was it? Was it for a hospital?
[CUSTOMER][POSITIVE] Yes, that is correct, yes.
[AGENT][NEUTRAL] OK, OK. Just making sure cause she has multiple.
[AGENT][NEUTRAL] And do you have the, and you said you do have the claim number, correct?
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] OK, and what is the claim number?
[CUSTOMER][NEUTRAL] 356-499-93
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the provider or the hospital name?
[CUSTOMER][NEUTRAL] It's Advocate Illinois Masonic Medical Center.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was the total bill amount?
[CUSTOMER][NEUTRAL] The total bill charges are 8,164 even.
[AGENT][NEUTRAL] OK, it looks like we paid $150 towards this.
[CUSTOMER][NEUTRAL] OK, so you, because I, that's where there's a discrepancy because this came electronically it doesn't give us the bill charges, but you do have the bill charges of 8,164, is that correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, I didn't see the bill charges for that, but I do see on.
[AGENT][NEUTRAL] Let me get back to it. I do see on here that it was for you said 8,164?
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] For the ER I am seeing that um amount. It looks like we paid $50 towards that amount and then it looks like she also had some imaging done and we paid $100 towards that.
[CUSTOMER][NEUTRAL] OK, and how was this claim process in network out of network or what network was used to price this claim?
[AGENT][NEUTRAL] So we don't do in and out of network we just pay um a certain amount and it looks like we only paid $150 towards this because she had met her um calendar year maximum.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is this like a third party, or does she have another insurance to confirm if this claim was processed out of network or in network?
[AGENT][NEUTRAL] Um, if she, let me see if she has a primary because we're not major medical, um, it looks like you would have to contact her if she has a major medical, um, because her employer would not be prov would not provide that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She would have to have that, I believe she'll need to talk with her employer, um, but I'm not showing any major medical on her side. So if she does, it would be through someone else. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So you guys did, um, OK, so yeah, cause it's kinda, yeah, this insurance, I never, we never heard of this insurance, that's why it's kinda um.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] OK, that works. OK, then, is there a reference number for this call?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So we don't have reference numbers, but you can use my name and last initial in today's date. So it'd be [PII], and today's date.
[CUSTOMER][POSITIVE] OK perfect thank you very much I gladly appreciate it thank you.
[AGENT][POSITIVE] OK. Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bye bye.