AccountId: 011433970860
ContactId: b66611be-97ee-45d8-a6a7-0ed34438cc1b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 278339 ms
Total Talk Time (AGENT): 102955 ms
Total Talk Time (CUSTOMER): 122826 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/b66611be-97ee-45d8-a6a7-0ed34438cc1b_20250328T18:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] My name is [PII]. I'm calling you from Homestead Hospital regarding a claim.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with claim status. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII] is the direct line.
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Yes, it is 02258741 ML.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Or [PII], [PII].
[CUSTOMER][NEUTRAL] Oh, I'm [PII]. I'm sorry.
[AGENT][POSITIVE] OK, thank
[AGENT][NEUTRAL] Yeah, got that. OK, thank you. And just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII] and the policy is still active. And would this be for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's an outpatient claim.
[AGENT][NEUTRAL] OK. And what's the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] [PII] to 725 [PII]. And the total charges were $38,475 even.
[AGENT][NEUTRAL] OK. Yes, ma'am. I'm showing that we received that claim on [PII] and it processed and denied on [PII] and it denied because we need the EOB from the primary insurance company.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right. So, I went ahead back on [PII].
[CUSTOMER][NEUTRAL] And I faxed those EOBs.
[CUSTOMER][NEUTRAL] Um, to your office, because the insurance neighborhood Health Partnership.
[CUSTOMER][NEUTRAL] They process the claim in two segments. Whenever they get a very large claim, apparently their system isn't able to process it in like.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] In its entirety, so they break it down into two segments. So they had two explanation of benefits and those are facts on [PII] according, uh along with the denial that we received from um APL.
[CUSTOMER][NEUTRAL] So can you check to see if that fax was ever received?
[AGENT][NEUTRAL] Right, I have the claim history pulled up and um it's not showing. Um what fax number did you send it to?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So let me look.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, the fax number we have is [PII].
[AGENT][NEUTRAL] OK. Yes, ma'am. That's the correct fax number. Um, you can resubmit the documentation and I can give you the claim number and also make sure that you, um, attention it again to the claims department and acknowledge the policy number also.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh I, I do have the claim number. Is it 349-6974 because like I said, I did attach your EOB, um, so I don't know why you didn't get it.
[AGENT][NEUTRAL] Um, yeah, yeah, that's the claim number.
[CUSTOMER][NEUTRAL] Is that the correct claim number that I should use?
[AGENT][NEUTRAL] Yes, ma'am. That's the claim number you should use and you can resend that EOB as well.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, and uh just make sure your attention to the claims department and we should get it this time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, uh, could you tell me your name again so I could document our conversation?
[AGENT][NEUTRAL] Yes, ma'am. My name is [PII]. Um it's spelled [PII] and my [PII] is [PII]. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, that was it. I'll go ahead and send the documents again.
[AGENT][POSITIVE] OK. Well, I thank you again, [PII] for calling APL. You have a great weekend. Mm bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Mm thank you.