AccountId: 011433970860
ContactId: e306fcec-1440-45af-88ea-9465497baeea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 421970 ms
Total Talk Time (AGENT): 151059 ms
Total Talk Time (CUSTOMER): 107001 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/e306fcec-1440-45af-88ea-9465497baeea_20250407T19:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, this is [PII] with Mercy Hospital and I had a question about a medical claim.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] D as in Delta 43302148
[AGENT][NEUTRAL] And the patient's last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um, how do you spell that?
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] OK, it's pulling it up. Give me one moment.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have her social?
[CUSTOMER][NEUTRAL] Uh yes, [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, and what was her date of birth?
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] And then I'm sorry, did you say claim status or benefits?
[CUSTOMER][NEUTRAL] Yes, claims.
[AGENT][NEUTRAL] OK, what was that data service?
[CUSTOMER][NEUTRAL] It's 8:16 of 24.
[AGENT][NEUTRAL] And the build out?
[CUSTOMER][NEUTRAL] $4,177.26.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I, I don't have a claim on file with that dollar amount. Who's the provider?
[CUSTOMER][NEUTRAL] Uh, Mercy Hospital [PII].
[CUSTOMER][NEUTRAL] And we received an EOB um so I do have a claim number if that helps.
[AGENT][NEUTRAL] Yes, what's the claim number?
[CUSTOMER][NEUTRAL] OK, 202408-230037.
[AGENT][NEUTRAL] Um, that would not be one of our claim numbers.
[CUSTOMER][NEUTRAL] It, yeah, so it came from 90 degrees.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] I think that's what their network is.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Did I give you her correct member ID number?
[AGENT][NEUTRAL] Well, so for the 90 degrees, um.
[AGENT][NEUTRAL] IMA processes the claims, but we do the claim status.
[AGENT][NEUTRAL] But I don't have that claim on file.
[AGENT][NEUTRAL] So I don't know. OK, let me try one more thing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, they denied it noncovered and it was just an electronic EOB and then we received a call uh from the patient stating that they needed medical records.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, we've got, you know, the only thing we have on file for that date is for anesthesia services.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me make sure and look at something else real quick.
[AGENT][NEUTRAL] She's got several different policies, but this should be the right policy. Um, it's a hospital indemnity plan. So, um, let's see, so you want to, let me give you the policy number that we have on file because the one that you gave me is different.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you want to file that with us um we can get it sent through for processing.
[AGENT][NEUTRAL] Because I've got some other claims on file for her, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, policy number is 249-7254.
[AGENT][NEUTRAL] And then I've got a payer ID, um, fax or mailing address.
[CUSTOMER][NEUTRAL] I'll take all of it.
[AGENT][NEUTRAL] OK. Payer ID is 60801.
[AGENT][NEUTRAL] The mailing address is [PII].
[AGENT][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And then the facts.
[AGENT][NEUTRAL] It's gonna be [PII].
[CUSTOMER][NEUTRAL] OK, and then her policy number you said was 249-7254?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, I'm not sure where they got that D number.
[AGENT][NEUTRAL] Well, so 90 degrees does, um,
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] They handle like.
[AGENT][NEUTRAL] They handle claims that are over $10,000 and price them so.
[AGENT][NEUTRAL] That's, that's where that comes into play. This is under 10,000, so you should be able to send it to us and we'll be able to get it processed, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][POSITIVE] OK, I think that's everything I needed then we'll go ahead and get this corrected. Thank you very much for your help today.
[AGENT][POSITIVE] OK, well thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Mm bye.