AccountId: 011433970860
ContactId: e2c69ffd-607a-4ebe-8738-4fcfde4b88f9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 406299 ms
Total Talk Time (AGENT): 172891 ms
Total Talk Time (CUSTOMER): 125887 ms
Interruptions: 4
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/e2c69ffd-607a-4ebe-8738-4fcfde4b88f9_20250331T18:53_UTC.wav
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[AGENT][NEUTRAL] Contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi [PII], my name is [PII] calling from Cancer Healthcare Associates calling on status on a claim.
[AGENT][NEUTRAL] I can help with claim status, [PII]. What is that policy number, please?
[CUSTOMER][NEUTRAL] 02094963 ML 8.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you. While I'm looking this up, if I could just have a callback number please in the event that we're disconnected.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] I appreciate that. What is the data service that we're looking for?
[CUSTOMER][NEUTRAL] 1114 24.
[AGENT][NEUTRAL] Is there a particular bill amount?
[CUSTOMER][NEUTRAL] It is uh do do hold on.
[CUSTOMER][NEUTRAL] 33867.
[AGENT][NEUTRAL] OK, thank you. I'm just checking now.
[AGENT][POSITIVE] Appreciate that. Thank you.
[AGENT][NEUTRAL] So it looks like we did receive your claim, um.
[AGENT][NEUTRAL] Just checking here, to be absolutely certain.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so we did receive your claim, um, that was, uh, received on um.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] The [PII], we processed it on the [PII]. Now this policy has a $1000 deductible that must be met prior to any of the benefits being paid out. So the benefits for this claim went towards that $1000 deductible.
[CUSTOMER][NEUTRAL] Now the $1000.
[AGENT][NEUTRAL] So the claim number on this is sure.
[CUSTOMER][NEUTRAL] OK, so, uh huh, go ahead.
[AGENT][NEUTRAL] And the claim number on this is 35576.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 70, but the uh benefits went towards the deductible.
[CUSTOMER][NEUTRAL] OK, so that would have been uh.
[CUSTOMER][NEUTRAL] $60.
[AGENT][NEUTRAL] Uh, it looks like it. Let's see.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I believe that is the case.
[CUSTOMER][NEUTRAL] Or the Medicare, no, I mean the Blue Cross B $60 with the co-payment, OK, OK.
[AGENT][POSITIVE] Right, that, that is correct, yes. Yeah.
[CUSTOMER][NEUTRAL] And do you have a call reference number?
[AGENT][NEUTRAL] Yes, my name is [PII], and we'll use that today's date as a reference. Is there anything else at all I can help with?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] I have two other claims for a different member.
[AGENT][NEUTRAL] OK, and what is that policy number, please?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It is 02216354 ML8.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And what day the service are we looking for?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII] for $2950.50.
[AGENT][NEUTRAL] So this is a facility charge, is that correct?
[CUSTOMER][NEUTRAL] facility.
[CUSTOMER][NEGATIVE] No provider um.
[AGENT][NEUTRAL] Provider, OK.
[CUSTOMER][POSITIVE] Not to worry, yeah.
[AGENT][NEUTRAL] OK, so the claim number for this.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] 3582321.
[CUSTOMER][NEUTRAL] 3
[AGENT][NEUTRAL] And it looks like there was uh a check that was issued to this. Let me just check it, uh, find out what the check number is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like the check number for this particular uh data service.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It's 203-592-6.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] It looks like that was processed.
[AGENT][NEUTRAL] On the, uh, we received it on the [PII], we processed it on the [PII], so that check is, is still in transit to you.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um how much was paid?
[AGENT][NEUTRAL] Oh, let's see.
[AGENT][NEUTRAL] Looks like that check is going to be for.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] $834.
[CUSTOMER][NEUTRAL] 84
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So on the same patient there's a different date of service.
[CUSTOMER][NEUTRAL] And the data services hold on.
[CUSTOMER][NEUTRAL] Come on
[CUSTOMER][NEUTRAL] [PII] for 291 18.
[AGENT][NEUTRAL] Yes, that claim number is 358.
[AGENT][NEUTRAL] 2319.
[AGENT][NEUTRAL] Now, it looks like we received that uh claim on the [PII], we processed it on the [PII], but these policies don't pay for that office visit. Um.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And so that was not covered.
[CUSTOMER][NEUTRAL] OK, so nothing done in office it's covered.
[AGENT][NEUTRAL] Uh, well, the, um, office visit, uh, is not covered. Uh, treatment or procedures within the physician's office is covered.
[CUSTOMER][NEUTRAL] Uh, well, the um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So office business not cover OK um.
[CUSTOMER][NEUTRAL] And last question, where can I get the copies of the EOB?
[AGENT][NEUTRAL] I can fax this to you. What is your fax number?
[CUSTOMER][POSITIVE] Exactly
[CUSTOMER][NEUTRAL] 954.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK. And I will um tell you that those are on, they are, uh they were just send in the mail uh on uh this morning and so they are on their way to you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] OK, well thank you for contacting AP have a good day.