AccountId: 011433970860
ContactId: dd34dfb4-70ee-490d-996d-98710aa540bc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 478019 ms
Total Talk Time (AGENT): 188797 ms
Total Talk Time (CUSTOMER): 116511 ms
Interruptions: 2
Overall Sentiment: AGENT=1.8, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/dd34dfb4-70ee-490d-996d-98710aa540bc_20250424T18:13_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider's office. Could you spell your name?
[AGENT][NEUTRAL] [PII] And how can I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII] OK.
[CUSTOMER][NEUTRAL] I'm checking for a claim status.
[AGENT][NEUTRAL] OK, I can certainly help with the claim status. What is that policy number we're looking at today?
[CUSTOMER][NEUTRAL] Yes. Policy number is 02473393.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] and uh [PII].
[AGENT][NEUTRAL] Thank you. Is there a contact number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is the data service that we're looking for for [PII]?
[CUSTOMER][NEUTRAL] And uh [PII].
[AGENT][NEUTRAL] OK. I'm, I'm sorry. Do you mind telling me again? I'm sorry. I'm having a little trouble with my earphone. What is the date again?
[CUSTOMER][NEUTRAL] [PII] date range.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] [PII]. OK, yes. OK, thank you. And uh is there a particular bill amount that I needed to look at?
[CUSTOMER][NEUTRAL] Yeah, bill amount is uh $25,283 even.
[AGENT][NEUTRAL] Thank you. It looks like we received your claim on the [PII].
[AGENT][NEUTRAL] And on the on the [PII], what we did was we asked for a more detailed explanation of benefits. So the explanation of benefits that we received.
[AGENT][NEUTRAL] Didn't give us a deductible co-payment or co-insurance.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, so what we're looking for is a deductible, co-payment or co-insurance for this, uh, so that we can finish, uh, processing the claim. So, um, that is what we're looking for. Now I can give you our fax number, mailing address, or it can be submitted online, but that is how this claim has been processed is that we're, we're looking for a more detailed explanation of benefits before we can finish processing it.
[CUSTOMER][NEUTRAL] OK. OK. So, we, when did you receive claim?
[AGENT][NEUTRAL] It looks like we received the claim on the [PII], and what we did was that, that is uh on the [PII], we asked for that more detailed explanation of benefits.
[CUSTOMER][NEUTRAL] Is a, is a BCBS or other inatimity insurance plan, [PII].
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] Uh, yes, that's, it's um APL and we're a gap insurance. That's.
[CUSTOMER][NEUTRAL] Bye
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. But uh, but we submit a paper claim on a hard copy on [PII] and uh you received early, how?
[AGENT][NEUTRAL] Yes, we did receive that one as well. It was just a duplicate of the of the original claim.
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] So we weren't able to process it. Uh, it's what, um, what we're needing is, is the, uh, explanation of benefits. So when we got this again, uh, we didn't, it didn't have the information that we were looking for. So it was, it was denied as a duplicate.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK. So we need to submit uh resubmit. We need to resubmit.
[AGENT][NEUTRAL] Yes, please. And the explanation of benefits needs to, um, needs to show uh exactly how much we're supposed to pay the deductible, co-payment or co-insurance.
[CUSTOMER][NEUTRAL] OK. As for your claim not on file, we, uh, we are submit the claim. May I have the payer ID?
[AGENT][NEUTRAL] It's 60801. Let's see here just a second here.
[CUSTOMER][NEUTRAL] 60801
[AGENT][NEUTRAL] Yeah, excuse me just a second. If you don't excuse me, just one moment, I'll be right back. Excuse me just one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, yes, if you don't mind sending that to us, I'm, I'm also going to see, um, I'm going to send the paperwork back and see if, if we can't, uh, use what we've got, but that is, um, uh, that is what we have is that we, we received that and we were wanting to know if there was a an uh a more detailed explanation of benefits, but, um, in the meantime, uh, and you do have our mailing address, I am going to see if, if the uh if the documentation that we've received can't be used.
[CUSTOMER][NEUTRAL] OK, may I have a call reference number?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII], and we're gonna use that today's date as a reference. Is there anything else I can help with?
[CUSTOMER][NEUTRAL] OK, [PII] and
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] Could you repeat from beginning? May I confirm?
[AGENT][NEUTRAL] Yes, uh,
[AGENT][NEUTRAL] You mean my, my name or, or, or what?
[CUSTOMER][NEUTRAL] Could you spell your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] And 2 days date, correct?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] OK, well, thank you for
[CUSTOMER][NEUTRAL] OK, we submitted, sorry, we.
[AGENT][POSITIVE] Yes, yeah, if you would please.
[CUSTOMER][NEUTRAL] We submit a claim again as, as per you claim not on file, correct?
[AGENT][POSITIVE] That's correct, yes. Mhm.
[CUSTOMER][POSITIVE] Oh OK, thank you so much.
[AGENT][POSITIVE] OK, well thank you for contacting APO.
[CUSTOMER][NEUTRAL] And I have, I'm checking for another, I'm, OK, I have, I'm checking for another.
[AGENT][NEUTRAL] You do have another one? OK, certainly. And what is that policy number?