AccountId: 011433970860
ContactId: a51f09b1-0c79-4f9c-9413-775eefe38606
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 514530 ms
Total Talk Time (AGENT): 188357 ms
Total Talk Time (CUSTOMER): 155868 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/a51f09b1-0c79-4f9c-9413-775eefe38606_20250310T15:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I'm calling in regards to a claim I had filed.
[AGENT][NEUTRAL] Sure, we just need to check on that status.
[CUSTOMER][NEUTRAL] Actually, no. So it um it came back with a note stating that it required, I believe, a um.
[CUSTOMER][NEUTRAL] Out of my bill and so I finally received it from the um facility.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I want to know how do I go about submitting since I had already filed the claim, um.
[AGENT][NEUTRAL] Oh sure, OK, yes, let me get that pulled up um I'll review that just to make sure and then um I'll let you know how you can get that to us um really quick if you don't mind, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Anything that sorry.
[CUSTOMER][NEUTRAL] Yeah it's gonna be [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yeah, 236.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 1422.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] Alright, and I'm just gonna verify some information now can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address we've got on file for you. It looks like it is a [PII] account.
[CUSTOMER][NEUTRAL] Yeah, it's my [PII].
[AGENT][NEUTRAL] Alright thank you so much for verifying all of that. OK, now do you happen to have that claim number this was in regard to?
[CUSTOMER][NEUTRAL] So I believe it's the one with let's see claim number.
[CUSTOMER][NEUTRAL] Yeah, I think it's the one
[CUSTOMER][NEUTRAL] With ending at 988.
[AGENT][NEUTRAL] 98. OK. All right.
[CUSTOMER][NEUTRAL] 354-898-888
[AGENT][NEUTRAL] Got it. OK, so for uh West Kendall Baptist Hospital?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, well this one is actually showing that it is a duplicate.
[AGENT][NEUTRAL] So let's see.
[AGENT][NEUTRAL] Was it for the date of service, uh, [PII]?
[CUSTOMER][NEUTRAL] Correct, yeah, it was an ER visit and they ended up admitting me in for a couple of days.
[AGENT][NEUTRAL] OK, there we are OK, so I did find that original claim, so you do have all of the necessary information that we were missing?
[CUSTOMER][NEUTRAL] I believe so. I mean, they, the representative I last spoke with told me that what they needed was the itemized bill.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So I finally received this from Baptist Hospital.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Sure, I'm also showing, um, I don't know if this was something that you had sent already or not um but it is stating that we need a more detailed copy of the EOB from your primary insurance, um, that shows what was applied to deductible copay or co-insurance. Um, if you don't have that, you can get that from the provider as well. Um, let's see, did you file this claim through our online portal?
[CUSTOMER][NEUTRAL] Yes, I did.
[AGENT][NEUTRAL] OK, so you could just send that information the exact same way um you could just upload that information you don't have to attach anything different um that's just that's showing that's all the information that we're needing so we'll be able to put that where it's supposed to go.
[CUSTOMER][NEUTRAL] OK, so all I would have to do is just uh.
[CUSTOMER][NEUTRAL] Send over the paperwork I have correct?
[AGENT][POSITIVE] Yes sir, that's correct.
[CUSTOMER][NEUTRAL] OK, I'm sorry. Give me just one second so I can log into my um insurance portal and see if I can get the other information you said you needed.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, bear with me just one sec.
[AGENT][POSITIVE] No, no, you're perfectly fine.
[CUSTOMER][NEUTRAL] OK, so uh I do have here.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] It says, I mean, I'm just not sure if if it says the claim my claim breakdown, and then it gives me like everything. I'm not sure if it's exactly what you're looking for. It says like sort of blue discount, um, amount my plan paid, my total savings for the services, and then it kind of breaks down my costs, like my co-pay.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] My deductible, my co-insurance and limit or exclusions, and then it says my total cost at the end.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This is through your um providers um where you went for treatment, is that right?
[CUSTOMER][NEUTRAL] No, this is actually through the insurance website through my um.
[AGENT][NEUTRAL] 00, through your major medical.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, um, honestly, no, I wouldn't be able to tell you for sure if that's what it is that we require without seeing it myself. What I always recommend is contacting the provider where you went for treatment and telling them that this is the information that you need. um, most of the time they'll be able to just send it to you electronically, um, but that way you know you know that you asked for what we were needing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, can I get the exact wording of what it is I'll be asking for?
[AGENT][POSITIVE] Yes absolutely let me know when you're ready.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] OK, so that is going to be the itemized statement.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That shows diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then uh a detailed copy of the primary explanation of benefits.
[CUSTOMER][NEUTRAL] Primary explanation.
[AGENT][NEUTRAL] That shows what was applied to co-pay, deductible and co-insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then that is it.
[CUSTOMER][NEUTRAL] OK, and that's
[CUSTOMER][NEUTRAL] That's uh something I wouldn't be able to receive through the insurance company directly.
[AGENT][NEUTRAL] Um, I honestly, I'm not sure again, this is just something I know the provider will have this information with everything that we need. Um, I'm not sure if you would get all of this detailed information straight from your your primary insurance.
[CUSTOMER][NEUTRAL] OK, understood. I'll try giving the facility a call then.
[AGENT][NEUTRAL] OK, did you have any other questions for me?
[CUSTOMER][POSITIVE] Um, no, I think that was all. Thank you so much for your time. I appreciate it.
[AGENT][POSITIVE] Of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you likewise.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][NEUTRAL] Bye bye.