AccountId: 011433970860
ContactId: cb6fd11d-70b5-4124-ab60-9e253d1538de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323380 ms
Total Talk Time (AGENT): 102077 ms
Total Talk Time (CUSTOMER): 154018 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/cb6fd11d-70b5-4124-ab60-9e253d1538de_20250226T19:02_UTC.wav
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[CUSTOMER][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, is it, I'm sorry, you said your name is [PII]?
[AGENT][NEUTRAL] Um, it's [PII], um it's spelled [PII]
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling with um employer Exotech. I have a group number.
[AGENT][NEUTRAL] OK. Um, this is the claims department. Did you need to check on the status of claims or either benefits?
[CUSTOMER][NEUTRAL] Yes, I'm calling to check on the status of a claim.
[AGENT][NEUTRAL] OK. Well, I would need the member's policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the policy number is, uh, I have 2 numbers here. So I have the one that says hospital benefit certification number.
[CUSTOMER][NEUTRAL] For the outpatient. Is that fine? So it's 024.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 279
[CUSTOMER][NEUTRAL] 24
[CUSTOMER][NEUTRAL] M as in Mary,
[CUSTOMER][NEUTRAL] L as in Larry, 7.
[AGENT][POSITIVE] OK, thank you. And could I get your name one more time and a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. My number here is [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII] and now please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] First name is [PII].
[CUSTOMER][NEUTRAL] Last name [PII], OK.
[CUSTOMER][NEUTRAL] Date of birth is.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and just let me advise you that verification of coverage does not guarantee payment of claims. Um, I'm showing the effective date on this policy was [PII] and the policy actually expired on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you need to check on the status of a claim.
[CUSTOMER][NEUTRAL] Correct. We were informed because um the procedure was done in [PII]. We were informed to still submit the claim, which we did on February.
[CUSTOMER][NEUTRAL] [PII] the fact. I'm just following up to see if you guys received it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the date of service on the claim?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 2nd, [PII].
[AGENT][NEUTRAL] OK, and what are the bill charges?
[CUSTOMER][NEUTRAL] The charges $500 yes.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, no, ma'am. I'm not showing a claim on file with that date of service and those bill charges. Um, how was the claim submitted?
[CUSTOMER][NEUTRAL] The effects
[AGENT][NEUTRAL] OK. Would you like to verify the fax number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 1 2nd.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, I, your fax has been sent to [PII].
[AGENT][NEUTRAL] OK. Yes, ma'am. That's the correct fax number. Was it attention to the claims department?
[CUSTOMER][NEUTRAL] Attention to claims, yes, um, I, we have the club, the group number and the name on the, the front page, the cover page.
[AGENT][NEUTRAL] OK, I apologize. I'm not showing it on file, but the claim can be resubmitted. There's no timely filing limit. And we also have a pair ID or the claim could be mailed in.
[CUSTOMER][NEUTRAL] OK, so if I submit it again now, can you, would you be able to confirm that you received it or I have to call back to see that you received it? Because I have confirmation that you received it. I don't know.
[AGENT][NEUTRAL] OK. Yes, ma'am. You can call or either you can go online and um check the status of it.
[CUSTOMER][NEUTRAL] I no longer have access to see anything online, so that's why we have to call and fax.
[AGENT][NEUTRAL] OK, well, yeah.
[CUSTOMER][NEUTRAL] So what I'm gonna do is I'm
[CUSTOMER][NEUTRAL] Mhm. Sorry.
[AGENT][NEUTRAL] Oh, go ahead. I'm sorry.
[CUSTOMER][NEUTRAL] I'm gonna fax it again, um.
[CUSTOMER][NEUTRAL] Um, can I call back before the end of the day when I fax it again? I just wanna make sure you receive it.
[AGENT][POSITIVE] Um, well, you can give us a call back within 3 business days.
[CUSTOMER][NEUTRAL] 3 business days. OK. OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] All right, um, I'm gonna send it again.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And I have attention to claims. Anything else? I just want to make sure this time you guys receive it.
[AGENT][NEUTRAL] Um, just make sure that your attention is to the claims department and the policy number is on there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Will do. Thank you.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] That's it for now. Thank you.
[AGENT][POSITIVE] OK. Thank you again, [PII] for calling APL. You have a great day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Mhm.