AccountId: 011433970860
ContactId: b0a0147e-6ccc-4a3b-8091-a607aaf25f51
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 459049 ms
Total Talk Time (AGENT): 116819 ms
Total Talk Time (CUSTOMER): 109878 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/b0a0147e-6ccc-4a3b-8091-a607aaf25f51_20250205T14:17_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, um, I'm calling to because we submitted medical records. I just, and we never received the determination afterwards, so I wanted to get an update on that.
[AGENT][POSITIVE] OK, sure, I can assist you with things. And may I have your name?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. Uh, first initial to my last name is [PII].
[AGENT][NEUTRAL] OK, and Mr. [PII], you're calling from a provider's office or this is your personal policy?
[CUSTOMER][NEUTRAL] Uh, provider's office.
[AGENT][NEUTRAL] OK, uh, what's the name of the facility or the provider you're calling from?
[CUSTOMER][NEUTRAL] Greenwich Hospital.
[AGENT][NEUTRAL] OK, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, uh, that would be [PII].
[AGENT][NEUTRAL] OK. Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, that would be 0166.
[CUSTOMER][NEUTRAL] 0259.
[CUSTOMER][NEUTRAL] I'm [PII].
[AGENT][NEUTRAL] Thank you. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK perfect. And what is the date of service for that claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Let me look at this information really quick. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you mind holding for me?
[CUSTOMER][NEUTRAL] Yes, that's fine.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Mr. [PII]. OK, I went ahead and pulled on the two the two claims that we received, and this was for um the total charge of 53535.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, no, the total charge for.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah, it was 19376.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Let me check on that.
[CUSTOMER][POSITIVE] Yeah, I also have a claim number also if that would help.
[AGENT][POSITIVE] Um, I think I got it.
[AGENT][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said you said medical records or you send the explanation of benefits from the primary insurance?
[CUSTOMER][NEUTRAL] Um, we sent medical records. Did you want the primary EOB?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Yeah, that's um the reason that we have denied the claim in the beginning is because we did not get the explanation of benefits from the primary insurance attached to it.
[AGENT][NEUTRAL] And that's what we were asking for.
[CUSTOMER][NEUTRAL] Oh, OK, OK, because we didn't send that, so I will get that sent over.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah OK and um what is, is that better to send by fax or by mail?
[AGENT][NEUTRAL] OK, go ahead and make a note.
[AGENT][POSITIVE] It's a little bit faster by fax because it will get here, um, it will be put into the account in 24 business hours once we receive it, and we'll go ahead and process within 7 to 10 business days by mail, it just takes longer because it needs to get here.
[CUSTOMER][NEUTRAL] OK and.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just to confirm, your fax number is [PII]?
[AGENT][POSITIVE] That is correct, yes. Mhm.
[CUSTOMER][POSITIVE] Correct, OK, thank you for that. I'll get that sent over.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Um, before you go, can I just have your name and a reference number, please?
[AGENT][NEUTRAL] Sure. My name is [PII]'s [PII].
[AGENT][NEUTRAL] And we don't have reference numbers you can use my name today.
[CUSTOMER][POSITIVE] OK, got it. Thank you so much for your help.
[AGENT][NEUTRAL] You're welcome. Is there anything else I can help you with today, Mr. [PII]?
[CUSTOMER][POSITIVE] Uh, no, that will be all, thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling ATL. Have a good day.
[CUSTOMER][NEUTRAL] Bye.