AccountId: 011433970860
ContactId: c6d5a746-f1c6-4118-ba09-1f29a1443eb8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1342520 ms
Total Talk Time (AGENT): 270951 ms
Total Talk Time (CUSTOMER): 297510 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/c6d5a746-f1c6-4118-ba09-1f29a1443eb8_20250506T20:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, sir. Uh, this is [PII] calling from Pror office checking on a claim status.
[AGENT][NEUTRAL] Right, next, happy to check on a claim. What's the policy number?
[CUSTOMER][NEUTRAL] 01648445
[AGENT][POSITIVE] Thank you. And a good callback number?
[CUSTOMER][NEUTRAL] [PII] is a direct line.
[AGENT][NEUTRAL] And patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Alright, and date of service?
[CUSTOMER][NEUTRAL] Um, the data services.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $57,103 even.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Do you have an amount after the primary?
[CUSTOMER][NEUTRAL] It's $500.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Claim is received on [PII].
[AGENT][NEUTRAL] Claim is claim was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there was a benefit payment sent in the amount of $500.
[CUSTOMER][NEUTRAL] So claim process and paid, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, could you verify the claim pay through check or EFT?
[AGENT][NEUTRAL] It was paid EFT.
[CUSTOMER][NEUTRAL] What is the EFT number?
[AGENT][NEUTRAL] Oh, I apologize. It was a single check. Check number is 2033819.
[CUSTOMER][NEUTRAL] OK it's a single checker.
[CUSTOMER][NEUTRAL] OK. Could you verify the uh check issue date and uh clear date.
[AGENT][NEUTRAL] Check was issued on [PII].
[CUSTOMER][POSITIVE] Can play it.
[AGENT][NEUTRAL] I don't have a clear date. I am showing the cash the check has been cashed.
[CUSTOMER][NEUTRAL] OK, the cash it.
[AGENT][NEUTRAL] I don't have a date. Yeah, I don't have a cash date.
[CUSTOMER][NEUTRAL] It's the same, [PII].
[CUSTOMER][NEUTRAL] OK, could you verify the check your address?
[AGENT][NEUTRAL] The check was issued to the insured.
[AGENT][NEUTRAL] Not to the provider.
[CUSTOMER][NEUTRAL] You said it's a, the claim $500 paid or is it applied to the member deductible?
[AGENT][NEUTRAL] It was paid to the member.
[CUSTOMER][NEUTRAL] Pay to the member means?
[AGENT][POSITIVE] Correct, it was paid to the insured.
[CUSTOMER][NEGATIVE] I'm not understanding. It's paid to the insurance insured means I am a provider. We, this $500 to pay to the provider only, right?
[AGENT][NEGATIVE] There was nothing paid to the provider.
[CUSTOMER][NEUTRAL] Why
[AGENT][NEUTRAL] I'm guessing that the insured.
[CUSTOMER][POSITIVE] You need for any specific uh yes.
[AGENT][NEUTRAL] Probably paid that amount. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], I'm gonna need to place you on a brief hold. Can you hold for one moment please?
[CUSTOMER][NEUTRAL] OK. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I understand.
[AGENT][NEUTRAL] Maybe I shouldn't be asking this in here.
[AGENT][NEUTRAL] That [PII]. Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good evening. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] in customer care. How are you this afternoon?
[CUSTOMER][POSITIVE] I'm good. How are you?
[AGENT][NEUTRAL] I'm doing all right. I was just wondering if you could answer a question on a claim for me. I don't need to transfer this if maybe you could just look at it.
[CUSTOMER][NEUTRAL] OK, can I get a policy number?
[AGENT][NEUTRAL] 1648445
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim number is 357-7677 for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm just trying to figure out why this was paid to the insured if the provider filed the claim.
[CUSTOMER][NEUTRAL] OK, that remark code DM 6428.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, that provider has a lien.
[CUSTOMER][NEUTRAL] Or something like that is to be notice was like a lien so we cannot send any information to uh them so I would probably just read off that information to them.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, come on, if anything comes up?
[AGENT][NEUTRAL] Oh, that's 642-8. I should have seen, OK.
[CUSTOMER][NEUTRAL] Why doesn't think.
[AGENT][NEUTRAL] You notice discrepancy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm. Are you, are you getting anything on your end?
[AGENT][NEUTRAL] I see that B notice now. I'm gonna try and find.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] and 420.
[CUSTOMER][NEUTRAL] So that basically let them lets them know that um.
[CUSTOMER][NEUTRAL] Uh, the, the, the payment I have to find that myself. Uh, let me pull up the dang it.
[CUSTOMER][NEUTRAL] And it lets them know that the payment went to the uh insured.
[CUSTOMER][NEUTRAL] Let me pull up the EOB.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Maybe that'll tell me more.
[CUSTOMER][NEUTRAL] Have to check and see.
[CUSTOMER][NEUTRAL] The system has been doing some crazy stuff today with our claims, so it might be doing it with the whole system.
[AGENT][NEUTRAL] It's hot.
[AGENT][NEUTRAL] It's just being like.
[CUSTOMER][NEUTRAL] Come on on babe.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And so on the EOB it gives uh a better description. It tells them that the benefits that they were unable to sign the benefits to the provider due to a discrepancy with their tax ID number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it also lets you know the decision has that the claim the benefits have been sent to the insured and of course you know that we don't give them that amount, the benefit amounts, is that correct?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Right, right, right, right. OK. All right, so as long as I know what to tell them, that is so helpful. Thank you so much for your time. I appreciate you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] No problem. No problem.
[AGENT][POSITIVE] Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] [PII], thank you for your patience and waiting.
[AGENT][NEGATIVE] So benefit payment was sent to the insured because we're unable to assign benefits to this provider. There was a discrepancy with the tax ID so a letter has been mailed to the provider with instructions on how to resolve this.
[CUSTOMER][NEUTRAL] Yes, yes, so what you need for primary OB.
[AGENT][NEUTRAL] No, it does not need primary EOB.
[CUSTOMER][NEUTRAL] Yes, but we have a, a letter on correspondingly received [PII]. It's stating it, please provide a copy of your expiring of benefits for your primary insurance carrier.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Correct, that was the original claim received, uh, the explanation of benefits was received.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Would you like a copy of this explanation of benefits for the claim?
[CUSTOMER][NEUTRAL] No, could you spell out your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, sure. Uh, shall I move the next one [PII] next number?
[AGENT][NEUTRAL] I need to notate this one and then we can check the next one. Give me just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the next member ID?
[CUSTOMER][NEUTRAL] 02465901
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII] sorry, [PII] and the date of the [PII].
[AGENT][NEUTRAL] Data service
[CUSTOMER][NEUTRAL] Mm, the data services 7-182024 and the bill amount is $27,307 even.
[AGENT][NEUTRAL] Right, so this claim was received on [PII].
[AGENT][NEUTRAL] Denied on [PII].
[AGENT][NEUTRAL] Denial reason is benefits are only payable if major medical provides benefits.
[CUSTOMER][NEUTRAL] OK, you need for primary or with this one?
[AGENT][NEUTRAL] Well, if the insurance paid, if the insured's primary paid on this, then it needs to be resubmitted with an explanation of benefits because what we have shows that they did not cover anything.
[CUSTOMER][NEUTRAL] OK. It's a previously centered on a primary on [PII]. And then the fax number is [PII]. It's the right fax number?
[AGENT][NEUTRAL] Mhm, correct. I don't show anything received.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you verify the claim number? I can do reset, reset with the primary first same fax number, right?
[AGENT][NEUTRAL] Mhm. 3504584.
[CUSTOMER][NEUTRAL] 4584. OK, shall I move the next one.
[CUSTOMER][NEUTRAL] This is the last one.
[AGENT][NEUTRAL] What's the next one?
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] The next one is.
[CUSTOMER][NEUTRAL] 02442009
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. The date of birth is, uh sorry, [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] OK, data service.
[CUSTOMER][NEUTRAL] Need services.
[CUSTOMER][NEUTRAL] Mm just a moment.
[CUSTOMER][NEUTRAL] It is [PII] and the bill amount is $9,751.25.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What was the bill amount again please?
[CUSTOMER][NEUTRAL] It's $9,751.25.
[AGENT][NEUTRAL] This claim was received and denied for an explanation of benefits needed from the primary.
[CUSTOMER][NEUTRAL] OK, could you verify the claim date and process date?
[AGENT][NEUTRAL] Clame was received 226 [PII] 2025.
[AGENT][NEUTRAL] Denied 227 of 2025.
[AGENT][NEUTRAL] And the claim number is 3,569,000.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 356.
[CUSTOMER][NEUTRAL] 9000. OK. Uh, we can send in the primary [PII] for same fax number, right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK. OK, sir. Can I get the reference number for the call?
[AGENT][NEUTRAL] Call references my name with my last initial and then today's date. My name again is [PII], that's spelled [PII], last initial [PII].
[CUSTOMER][POSITIVE] OK, sir. Thank you. Thank you for your assistance.
[AGENT][POSITIVE] You're welcome. Have a good day.