AccountId: 011433970860
ContactId: f9fb91ef-ab3e-4dc2-b364-4e386778e76d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 791690 ms
Total Talk Time (AGENT): 272991 ms
Total Talk Time (CUSTOMER): 263462 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/f9fb91ef-ab3e-4dc2-b364-4e386778e76d_20250422T19:15_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes [PII], this is [PII] at Lakeland Regional Medical Center. I'm calling in regards to a patient's claim.
[AGENT][NEUTRAL] OK, [PII], you have one patient that you need to check claim status on? Is that
[CUSTOMER][NEUTRAL] Yes ma'am, just a clarification.
[AGENT][NEUTRAL] At
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, I can help you with that. You're just needing clarification on the status.
[CUSTOMER][POSITIVE] Uh, yes, because we do have, uh, like an explanation of benefits from you.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, yes ma'am, [PII], I can help you, but uh first let me get some additional information from you. What is a good callback number for you please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number.
[CUSTOMER][NEUTRAL] OK, the policy number that we have, let me see.
[AGENT][NEUTRAL] Please.
[CUSTOMER][NEUTRAL] I have 01819429.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And [PII], any information that I do provide today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is it [PII] with just a [PII] or [PII]?
[AGENT][NEUTRAL] Neither, it's [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, and then again, any information that I provide for you today would be a verification of benefits and not a guarantee of payment. What is the uh date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Uh, the day of service is [PII] with the bill amount.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] $14,911.53.
[AGENT][NEUTRAL] OK, thank you, and the claim number that you have?
[CUSTOMER][NEUTRAL] Let me see if I can read it off the sheet.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Uh, that client OK, let me see, it's a little, so let me see if I can read it 358 5.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] 5324.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And you did say 32 of 25, is that correct?
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] The data service is 322 of 2025. Is that right, [PII]?
[CUSTOMER][NEUTRAL] I didn't hear you.
[CUSTOMER][NEUTRAL] OK, yeah, 322 of 2025, yes.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, just hold up.
[CUSTOMER][NEUTRAL] It's like I I think I looked it look like she have uh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so on the, this group is currently in renewal, the remarks states we've received.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Your claim, however, it is pending.
[CUSTOMER][NEUTRAL] Oh, you
[CUSTOMER][NEUTRAL] OK, I don't know. You, you like you go in and so, yeah, OK, now I can.
[AGENT][NEUTRAL] Can you hear me?
[AGENT][NEUTRAL] OK, so the remark on this explanation of benefits states we've received your claim, however, it is pending due to benefit renewal information from your employer group. Once the information is received, we'll continue processing your claim.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, OK, so how long does that take?
[AGENT][NEUTRAL] I can't, mm, yes, ma'am. I don't, I can't give you a specific.
[CUSTOMER][NEUTRAL] I well I put the I.
[AGENT][NEUTRAL] [PII] on that I can just see that this, I just checked that and they are still in their renewal process.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK, um, oh yeah, I was thought all this would have been taken care of by the beginning of the year.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] So the date of this, yes, their renewal is not [PII].
[CUSTOMER][NEUTRAL] So I I.
[CUSTOMER][NEUTRAL] Yeah, no, I'm like, you know how you do your renewal like at at the end of towards the end of the year.
[AGENT][NEUTRAL] Right, but that's, no, ma'am, that's not how the group, these groups are set.
[CUSTOMER][NEUTRAL] So you
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, no, ma'am. They renew all year long.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Oh, OK, it's oh.
[CUSTOMER][NEUTRAL] So are, are y'all leaving these to like patient responsibility or?
[AGENT][NEUTRAL] No, ma'am. We never determine patient responsibility anyway because we're not a major medical carrier. This is just a supplemental plan.
[AGENT][NEUTRAL] So again, this is in a holding pattern until the group's completed their renewal.
[AGENT][NEUTRAL] And then the claim will continue processing.
[CUSTOMER][NEUTRAL] OK, um
[CUSTOMER][NEUTRAL] But you are secondary to her Blue Cross and Blue Shield.
[CUSTOMER][NEGATIVE] Oh yeah I don't coordinate.
[AGENT][POSITIVE] That is correct, yes ma'am.
[AGENT][NEUTRAL] We, we can't, we're not a major medical insurance. This is only
[CUSTOMER][NEUTRAL] But what you don't call.
[CUSTOMER][NEUTRAL] OK, so you don't coordinate.
[AGENT][NEUTRAL] This is only a supplemental policy that helps with co-pays, deductibles, and co-insurance amounts of coverage services.
[CUSTOMER][NEUTRAL] OK alright and so right now the um group is in um renewal and we don't know how long that can take.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um,
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, now do you have any of her January and February dates of services?
[AGENT][NEUTRAL] Uh, you would have to give me, I'll be happy to check. You'll have to provide me each data service and the total bill amount and we'll have to do them one at a time.
[CUSTOMER][POSITIVE] I'll be happy to check.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, make sure that you, you have those, um, this one is for [PII].
[AGENT][NEUTRAL] For me to check those.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the bill amount on this one is $5,142.05.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, one moment.
[AGENT][NEUTRAL] That claim has been received. It's also in the same holding pattern and that claim number is 357-0608.
[CUSTOMER][NEUTRAL] OK, so that one is in a holding, um, let me see here what else we have.
[CUSTOMER][NEUTRAL] Um, I have a data service of 27 of [PII] build amount $5,142.05.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and the claim number for this one is going to be 358.
[AGENT][NEUTRAL] 2817 and it is in the same.
[AGENT][NEUTRAL] Holding pattern.
[CUSTOMER][NEUTRAL] OK, OK, and um.
[CUSTOMER][NEUTRAL] Mm, my last data service that I know you pro you should have is uh what's it [PII] of [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The total bill amount.
[CUSTOMER][NEUTRAL] And the total bill amount on that one is $5,142.05.
[AGENT][NEUTRAL] And that one is not on file. We do not have that one.
[CUSTOMER][NEUTRAL] OK, why I don't have that one.
[CUSTOMER][NEUTRAL] OK, it was just released on [PII], so it may take a while.
[AGENT][NEUTRAL] When
[AGENT][NEUTRAL] OK, so yes, because we.
[AGENT][NEUTRAL] We'll have to have a copy of the primary insurance company that benefits along with the claim for review.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] Um, are you, uh, do you have those on file?
[AGENT][NEUTRAL] And then just for a few.
[AGENT][NEUTRAL] No, ma'am, we don't. They would need to be provided by whomever files the claim. We've received them, I'm assuming on the other ones, but yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there a fax number?
[CUSTOMER][NEUTRAL] Just in case the
[AGENT][NEUTRAL] It's [PII] attention claims department.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Hold on, you went, you went out 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[AGENT][NEUTRAL] Attention claims department.
[CUSTOMER][NEUTRAL] OK, I, I heard [PII] attention claims department.
[AGENT][POSITIVE] That is correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, is that.
[AGENT][NEUTRAL] And then for future reference if you ever need an explanation of benefits on a claim that we process we do have a portal monica in which you should be able to print this from.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And the website for that is secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what was.
[CUSTOMER][NEUTRAL] Is there a call reference number?
[AGENT][POSITIVE] Yes ma'am you would use my name along with today's.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else that I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] No ma'am, that's it.
[AGENT][POSITIVE] OK, well then thank you so much for calling APO and I hope you have a very nice rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.