AccountId: 011433970860
ContactId: d2db582c-1800-4633-aed0-0a937ebea31c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 393700 ms
Total Talk Time (AGENT): 150922 ms
Total Talk Time (CUSTOMER): 190256 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/d2db582c-1800-4633-aed0-0a937ebea31c_20250527T18:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hey, how are you doing today?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] Doing pretty good, just watching it rain.
[AGENT][POSITIVE] How can I help today?
[CUSTOMER][NEUTRAL] Uh, I was wanting to call and see if I was processing, getting some claims processed and all there. I've been getting a bunch of bills and I've called them and they said they had sent to y'all but hadn't heard anything and I just want to make sure that y'all I got some of them and you could check for me.
[AGENT][NEUTRAL] OK. What is your policy number?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 01526349
[AGENT][NEUTRAL] Thank you. And then if I could get your first name, last name, date of birth.
[CUSTOMER][NEUTRAL] Try [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, Mr. [PII]. And then if you'll verify, please, your physical address on file for me.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. We and the claims, um, should they be under your name?
[CUSTOMER][NEUTRAL] Uh, part of them is for me and part of them is my wife's, [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Couple of them is from the Labor where we had blood and now we're gone. They said they had sent it in months ago and hadn't heard nothing and I told them that, make sure that they had been uh one of them explanation of benefits. They said they had that they would resubmit it again, so.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I just
[CUSTOMER][NEUTRAL] Kind of see if there's been a hold up or something other than that, got a bill from the doctor's office that they did.
[CUSTOMER][NEUTRAL] All the insurances that had been filed and I, I still shows nearly $4000.
[AGENT][NEUTRAL] OK, so there was one claim that I see under your name uh for a recent date of service for [PII].
[AGENT][NEUTRAL] It was from Capstone Rural Health Center, it looks like.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So that, that claim was received, um, and it looks like processed.
[CUSTOMER][NEUTRAL] Yeah, I
[AGENT][NEUTRAL] Uh, looks like
[AGENT][NEUTRAL] Yeah, that one, that's the only recent one that I show for you.
[CUSTOMER][NEUTRAL] Yeah, on the website there it shows 31 for me and, and 2 for my wife, [PII].
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] But uh I was wanting to check on some of these other y'all y'all don't have, you don't have nothing else pending or showing or received or nothing.
[AGENT][NEUTRAL] No, I mean, everything that's been sent to us, um, recently for both of you has been paid. I don't show um that there were, you know, so there were 2 for [PII] and then 1 for you. Those have been processed and paid. The only thing that's not covered under the policy looks like, like office visits aren't covered as far as like the office visit fee.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, so that
[CUSTOMER][NEUTRAL] The, the lab, the, the lab and all that, they, you know Healthcare applied it towards the deductible or the co-pay and you're usually pay and that's reason I was asking.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah, I mean, I don't
[CUSTOMER][NEUTRAL] We've got about
[AGENT][NEUTRAL] I don't see any.
[CUSTOMER][NEGATIVE] Got about 6 or 8 claims. Yeah, I've got about 6 or 8 claims they want me to pay that said it had been processed and, and it don't show that y'all had paid any now that want to see if y'all had got them or, or what the problem is on if y'all hadn't received them or what.
[AGENT][NEUTRAL] If it's, yeah, I mean if it's from a quest diagnostic like lab type place, I don't see anything from that facility recently and I'm checking everything for [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, and there should be some for me and the wife, both from Doctor Sibley Cardiology PC over in [PII].
[CUSTOMER][NEUTRAL] The data service on that would have been the.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] [PII] and [PII] should have been for both of us and they say that they, it's been, been sent to y'all and but I don't know.
[AGENT][NEUTRAL] Yeah, I mean, I don't.
[AGENT][NEGATIVE] See anything else under your name, so definitely not for you.
[AGENT][NEUTRAL] Um, the two that I see for [PII], one was for Southeastern Regional Medical Center.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then one was for City of Hope Medical Group on [PII]. I don't see anything else.
[CUSTOMER][NEUTRAL] Over [PII]
[CUSTOMER][NEUTRAL] OK. I, uh,
[AGENT][NEUTRAL] So if they're saying that they've, yeah if they're saying that they've submitted them then they need to contact us to see if maybe they're sending it to the wrong place um because they said that they haven't received anything back so the only thing we can do is just verify the information as far as like where they're sending the claim info to.
[CUSTOMER][NEUTRAL] To talk to someone.
[CUSTOMER][NEUTRAL] Yeah, that's what I wanted to make sure, yeah. Yeah, I talked to the Labor group here, this and for the lab and tests and stuff there, uh, last Wednesday or Thursday, and they said that they would resubmit it to y'all and if it's still not showing up, that's what I was wanting to uh
[CUSTOMER][NEUTRAL] To check and see
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEGATIVE] Yeah, I mean, I, I unfortunat[PII] don't see anything.
[CUSTOMER][NEUTRAL] OK, well, I'll get back a hold of them and see if they can get them resubmitted or something over there to y'all then.
[AGENT][POSITIVE] OK. All right, sounds good. Anything [PII]e I can check on for you?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Alright well thanks for calling APL. Have a nice day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye bye.