AccountId: 011433970860
ContactId: f8b9213e-4682-4d99-b2b6-f73aad75bc5f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 720380 ms
Total Talk Time (AGENT): 199709 ms
Total Talk Time (CUSTOMER): 280000 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/f8b9213e-4682-4d99-b2b6-f73aad75bc5f_20250331T19:14_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from Emory Healthcare. Um, what was your name, please?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Alright, um, what would you like from me? I'm calling about a claim.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, sure. I can assist you with claims. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 02283629.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][POSITIVE] OK perfect, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, and what's the date of service and the amount of the claims?
[CUSTOMER][NEUTRAL] Data service 8 1324 in the amount $1,969.
[AGENT][NEUTRAL] Great, thank you. Let me see if I have this claim. And for future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] that's the original. OK, bear with me just a second and we processed twice. So let me pull the original claim.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] Waiting on the system.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] And this is for Emory Hospital?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Hillendale Emmy Hillendale Hospital.
[AGENT][NEGATIVE] Yeah. All right. So it looks like the first time that we processed, which is, which is the original one, it was processed [PII] and it was denied. And the reason for this denial is the calendar your maximum for diagnosis, diagnostic benefits has been exhausted for the year.
[CUSTOMER][NEUTRAL] A moment please. OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Calendar maximum for what diagnostic is that what you said?
[AGENT][NEUTRAL] Diagnostic services. Yes, uh-huh.
[CUSTOMER][NEUTRAL] OK, go ahead please diagnostic services.
[AGENT][NEUTRAL] Has been met for the year.
[CUSTOMER][NEUTRAL] Um, so what kind of policy is this?
[AGENT][NEUTRAL] This is a limited hospital indemnity policy.
[CUSTOMER][NEUTRAL] Unlimited.
[CUSTOMER][NEUTRAL] You said limited hospital indemnity policy, yes?
[AGENT][POSITIVE] Yes, yes, that is correct, yes. Mhm.
[CUSTOMER][NEUTRAL] OK, alright, just a second for me please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] What is that claim number?
[AGENT][NEUTRAL] The claim number is 3,562,140.
[CUSTOMER][NEUTRAL] One moment. OK, and it.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, just a second. What I'm trying to do is see 88888.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I'm trying to see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No user was found with the information please try again contact. OK, so I'm trying to sign up for your portal. It didn't let me. I'm going through the new user.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I hit the medical provider next I put my tax ID [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] [PII] it asked me for the patient account number and I have it as [PII].
[AGENT][NEUTRAL] Mhm. And what number?
[CUSTOMER][NEUTRAL] One, OK? And.
[AGENT][NEUTRAL] Bear with me just a second.
[CUSTOMER][NEUTRAL] I hit next. OK, so the patient account must match the numbers you listed on the submitted claim form, um, looking at the claim form, yeah, that's exactly what it is.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then hit next.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, and now it's asking me to create the username [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK. And now I accept.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Check it next.
[CUSTOMER][NEGATIVE] There was an error, technical difficulties.
[CUSTOMER][NEUTRAL] Are you serious man?
[CUSTOMER][NEUTRAL] OK, let's try it. I don't know what happened here.
[AGENT][NEUTRAL] Is it more than likely.
[CUSTOMER][NEUTRAL] So I don't know if it took or not because it's just.
[AGENT][NEUTRAL] Yeah, I can check. One moment. Let me, let me go back to that page. OK, one moment.
[AGENT][NEUTRAL] OK, what's what's the tax ID?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK let me try that.
[AGENT][NEUTRAL] Is this your first time trying to um register?
[CUSTOMER][NEUTRAL] Yes, yes, it is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] 3 31 1219, so this this year.
[AGENT][NEUTRAL] Yeah, it didn't take the password, your user ID of the password.
[CUSTOMER][NEUTRAL] It didn't take it.
[AGENT][NEUTRAL] No. Mm mm.
[CUSTOMER][NEGATIVE] Alright, we got 1 lowercase, one number, 8 character minimum, one uppercase, one symbol must not contain username, none of that.
[AGENT][NEUTRAL] Your yeah, the username cannot be your email so you can put like the first part of your email or something like that and then just create a password.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It it's, it's not the um it's not to use the the email um it has a space for the email, so I did enter that information right now it's saying submitted.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, it says it was commit uh, let's see, let's see.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah, I see here.
[CUSTOMER][POSITIVE] OK, OK, well, let me just put you see it already. How that's cool, that's awesomely cool, um, OK, let me put in my claim number and see what it tells me.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So I have to put in the patient first name [PII]
[CUSTOMER][NEUTRAL] OK. And the date of birth.
[CUSTOMER][NEUTRAL] [PII]im found. OK, here we go.
[CUSTOMER][POSITIVE] Oh man, I love when they're this quick and I get immediate um access.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm waiting for it to pull it.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] This is so so helpful.
[CUSTOMER][NEUTRAL] Um, all right, so I, it's trying to pull. I don't see anything. It disappeared. It's still doing something.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, it should upload like download it to your, OK, OK.
[CUSTOMER][NEUTRAL] Um, OK, I see, I see popped up.
[CUSTOMER][NEUTRAL] Very nice, um, OK, so now I have what I need because I need the EOB also, um, I will take the, um, call reference if you guys have call reference.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] We don't. You can use my name in today's date and um Ms. [PII], one more time, one more question. I'm so sorry. Um, the one that you pulled, is it the most recent one which you say duplicate or is it the original one? Because if you pulled, sometimes they will pull the duplicate one if that's the last one. But if you did pull that one, then I can give you the um the one, the, the claim number for the original one, and you can try that if you want.
[CUSTOMER][NEUTRAL] Well, I have the claim number that I have is 3,562,140. Is that the original?
[AGENT][NEUTRAL] OK, so, yeah, that's the original one, so yeah, you should get the correct information on that one. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so this one says that that 0 is paid on. Oh, the account I see, I see, so the full amount nice. OK, so what is your last name initial so?
[AGENT][NEUTRAL] Mhm. Yeah. Yeah. Mhm. Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right, thank you very much. Thank you very much for your assistance. Thanks for waiting while I work through that portal um because it's always, always helpful to have access. You have a good rest of your day.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] OK no problem.
[AGENT][POSITIVE] No problem.
[AGENT][POSITIVE] Yeah. You as well, Miss [PII]. Thank you for calling APL. Have a good week.
[CUSTOMER][POSITIVE] All right you too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.