AccountId: 011433970860
ContactId: d30d6cc2-0b7b-4b9f-bdff-1c2533aa4e19
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 192539 ms
Total Talk Time (AGENT): 66552 ms
Total Talk Time (CUSTOMER): 92967 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/d30d6cc2-0b7b-4b9f-bdff-1c2533aa4e19_20250429T12:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi Ay, it's [PII]. I'm transferring Erica Church with the broker's office. She has some questions concerning [PII].
[CUSTOMER][NEUTRAL] And his policy number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's 02517410.
[CUSTOMER][NEUTRAL] The date of service [PII].
[AGENT][NEUTRAL] And [PII] is the patient?
[CUSTOMER][NEUTRAL] I did verify the last, yes, um, I did verify the date of birth and the last four of his social.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you can send her over.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] Mhm, thank you.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is Erica Church calling with World Insurance, and I am calling to follow up on the EOB for um a member.
[AGENT][NEUTRAL] OK. Could you please verify his name and date of birth?
[CUSTOMER][NEUTRAL] Sure, first name is [PII] Last name [PII], [PII], and date of birth is [PII].
[AGENT][NEUTRAL] OK. Thank you. And what's the claim number, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, claim number is 358-8980.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yes, ma'am. I'm showing that this claim is denying because um the primary carrier EOB that was sent along with the claim, um, we have the ELB but it's not showing exactly which amounts went towards the copay, the co-insurance, or the, the deductible. And under this policy, that's the only portions um of the claim that we pay.
[AGENT][NEUTRAL] So if we could get an updated explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Get the full, full EOB? OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Oh you got it. I know he has several with that issue, so, OK, perfect. I will, I will let him know.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] And then uh it yeah uh when I have um the EOB can I submit it to ABL ATL customer service via email?
[AGENT][NEUTRAL] Um, no, ma'am. You guys would have to go through the OSC and refile the claim.
[CUSTOMER][NEUTRAL] Through the portal?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK perfect OK that's fine thank you so much.
[AGENT][NEUTRAL] OK. And um just make sure that you reference the claim number also.
[CUSTOMER][NEUTRAL] OK, I will, but you guys have the itemized bill?
[AGENT][POSITIVE] Yes, we do.
[CUSTOMER][NEUTRAL] OK, so, uh, all I would need to do is just submit the EOB.
[AGENT][POSITIVE] Yes, ma'am, that's correct. The full EOB.
[CUSTOMER][POSITIVE] OK per perfect thank you so much.
[AGENT][POSITIVE] OK, thank you again, [PII] for calling ATL.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Thank you have a wonderful day bye bye.
[AGENT][NEUTRAL] You do the same. Bye.
[CUSTOMER][NEUTRAL] Bye.