AccountId: 011433970860
ContactId: f687229c-8722-47c9-9f99-f9fdb64a91c2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 381420 ms
Total Talk Time (AGENT): 217498 ms
Total Talk Time (CUSTOMER): 128519 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/f687229c-8722-47c9-9f99-f9fdb64a91c2_20250221T14:09_UTC.wav
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[AGENT][NEUTRAL] For contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. I'm not sure if I'm calling the right place or if I hit the right option. Um, I'm calling from a, um, sorry, an outpatient ambulatory surgical center and I'm just trying to see if you guys received a claim for a patient.
[AGENT][NEUTRAL] I can certainly look up a claim and with whom am I speaking, please?
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] [PII], OK, thank you. And what is that policy number that we're looking at today, please?
[CUSTOMER][NEUTRAL] OK, the number that I have is 17,750.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Maybe we can find it by their name. Let me just check here.
[CUSTOMER][NEUTRAL] I was trying to see if I had another car because I'm like, I don't know if that's really a policy number. Um.
[AGENT][NEUTRAL] Yes. Um, how do you spell their last names?
[CUSTOMER][NEUTRAL] It is [PII]
[AGENT][POSITIVE] Thank you. And the first name?
[CUSTOMER][NEUTRAL] Um, I'm gonna spell that is [PII]
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Thank you. And if I could have a callback number while I'm looking at uh Gayla's policy.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Great, thank you. What is your date of birth, by the way, to make sure the right person.
[CUSTOMER][NEUTRAL] The patient date of birth is [PII].
[AGENT][POSITIVE] Thank you. Her policy
[CUSTOMER][NEUTRAL] I have an inho. Oh, go ahead, you found it?
[AGENT][NEUTRAL] Oh, yes, um, it, uh, her policy ends in 287.
[AGENT][NEUTRAL] It might be listed on that, on that card as being inpatient or outpatient surgery. I mean, it's uh patient benefits. That's, that's the policy number.
[CUSTOMER][NEUTRAL] It ends in, it ends in 287.
[AGENT][NEUTRAL] Yes, the policy number is 01.
[AGENT][NEUTRAL] 42
[AGENT][NEUTRAL] 2287.
[CUSTOMER][NEUTRAL] OK, it's a different number on here to say in hospital benefit cert number and then I because I I was able to find her card and then there's another one that said outpatient benefit cert number, so that that's not the correct number. It's 0.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] What have you got?
[CUSTOMER][NEUTRAL] Um, for outpatient benefit cert number is 1252290ML5 is what I have.
[AGENT][NEUTRAL] Oh, OK. So, um, that, that would have worked as well whenever they um uh renew as a group, whenever they, they renew their policy as a group, they always get a new number, uh, and that's, that's not a problem. Um, it's confusing but it's not a problem. Uh, that's how we, we find them, uh, usually is by their names. So, um.
[AGENT][NEUTRAL] The policy that's the correct one is the one ending that I just told you about that ends in 287. Now, this policy went into effect on [PII]. It is active. This is a secondary or gap insurance. It's meant to pick up the deductible, co-payment or co-insurance for in and out of hospital settings. Now, for an outpatient ambulatory surgery center, we will pick up the deductible, co-payment or co-insurance from her major medical.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Up to $2500 per calendar year. Now that is a calendar year benefit, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But that is what these policies are meant to do.
[CUSTOMER][NEUTRAL] OK. So this was for [PII].
[AGENT][NEUTRAL] That, that would be fine.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, and, uh, so August, uh, you said [PII], did you say or [PII]? I'm sorry, you said [PII].
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Yes, OK. So the claim that we have for that, uh, the claim number is um 35.
[AGENT][NEUTRAL] 631-82.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] The, um, as I mentioned before, she has $2500 for a benefit per calendar year. Now, when we received your claim, uh, let's see if I can find it here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Alright
[AGENT][NEUTRAL] OK, we received your claim on [PII]. We processed it on the [PII] [PII].
[AGENT][NEUTRAL] Now, at that time, she had a remaining balance of $795.94. So on the [PII] of this month, actually it would have gone out on the [PII], um, last Friday.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We send a check to you in the amount of $795.94. Now, that is the remaining balance that she has for the calendar year [PII].
[AGENT][NEUTRAL] And I realized that is not the, the, the amount of the total charge that uh but that was the remaining benefits that she had. I can give you the check number, um, I can uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that would be great.
[AGENT][NEUTRAL] It's 202-754-6. Now she may very well have another um uh gap insurance. I, I don't really know, um, but uh for our policy, that was, that's the most, that's the end of our contractual obligation is that, is that check that's coming to you.
[CUSTOMER][NEUTRAL] OK, and that was issued on [PII]. OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Awesome. Um, and what's your first name?
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last [PII] [PII].
[AGENT][NEUTRAL] We at today's date as a reference.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much, [PII], for your help. Now, is there, um, do you have um explanation of benefits or no for the patient?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, yes, that will be coming to you along with the check. Mhm.
[CUSTOMER][NEUTRAL] Could you
[CUSTOMER][NEUTRAL] OK, cause I was gonna ask, could you fax it over to me?
[AGENT][NEUTRAL] Sure, what is your fax number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, I'll have that for you. Um, [PII], is there anything else I can help with?
[CUSTOMER][POSITIVE] Nope, that is it. Thank you so much for your help.
[AGENT][POSITIVE] Thanks for contacting AP have a good day.