AccountId: 011433970860
ContactId: fa1b06ee-d745-42fd-9551-117c99caaeca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 515859 ms
Total Talk Time (AGENT): 295264 ms
Total Talk Time (CUSTOMER): 151280 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/fa1b06ee-d745-42fd-9551-117c99caaeca_20250624T17:59_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I'm calling from Cell Regional Health.
[AGENT][POSITIVE] OK, yes, I have, how may I help?
[CUSTOMER][NEUTRAL] I wanted to get the claim status, [PII].
[AGENT][NEUTRAL] Yes, I can help with the claim status. What's that policy number, please?
[CUSTOMER][NEUTRAL] Sure, uh, [PII], can you please come closer to your mic because, uh, your voice is coming from afar.
[AGENT][NEUTRAL] Yeah, I'm, I'm sorry. I'm having trouble with my phone. It's just gonna, I'll try and shout, but I mean, um, that's, I'm just having trouble with it right now. What's the policy number?
[CUSTOMER][NEUTRAL] That's OK, that's OK.
[CUSTOMER][NEUTRAL] So the policy number is 01841268.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Sure. That is [PII].
[AGENT][NEUTRAL] OK, OK. Excuse me just a second, um.
[AGENT][NEUTRAL] I may have to call you back. I'm having trouble with my phone. Oh, here we go. It's, I was having trouble with my computer as well. It's just one of those days. OK, I just need a callback number please in the event that we're disconnected.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Yeah, so the callback number is [PII].
[AGENT][POSITIVE] Thank you. What
[AGENT][NEUTRAL] [PII]. Thank you. What is that data service that we're looking at for [PII]?
[CUSTOMER][NEUTRAL] D of service is.
[CUSTOMER][NEUTRAL] May 24, 2024.
[AGENT][NEUTRAL] And is there a bill amount?
[CUSTOMER][NEUTRAL] And total
[CUSTOMER][NEUTRAL] Yeah, total charge amount is $12,567.33.
[AGENT][NEUTRAL] OK, so this is a facility bill, right? That's what it sounds like, OK.
[AGENT][NEUTRAL] OK. So what we have on this, uh, your claim is, um, your claim number is 348.
[AGENT][NEUTRAL] 553 1.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] The um
[AGENT][NEUTRAL] The claim that these policies only pay a certain amount per calendar day.
[AGENT][NEUTRAL] So what ended up happening is, is that we ended.
[CUSTOMER][NEUTRAL] OK, so you are saying.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] This policy, this policy only pay uh for policy, uh pay the certain amount only, right?
[AGENT][NEUTRAL] Yes, that's true, but there's also what I was gonna tell you is that there's a $250 deductible for each calendar day. So your payment on this would have been.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] $2,257.10.
[AGENT][NEGATIVE] But what they did was they took out that $250 deductible first before paying me.
[AGENT][NEUTRAL] That's why you didn't get as much money. I mean, you didn't get the entire amount if that is what your, your question is, is that there's a deductible on these that has to be met to go.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, so [PII], as per you saying that uh this policy only pay the certain amount which is $250 is uh like for the deductible for the entire year, right?
[AGENT][NEUTRAL] That for the entire day, it's, it's uh every day that they do that.
[CUSTOMER][NEUTRAL] OK, sorry.
[CUSTOMER][NEUTRAL] For entire day, right? I get it. And uh you said something too.
[AGENT][POSITIVE] Yeah, absolutely they do it each and every day.
[CUSTOMER][NEUTRAL] Yeah, and you said something 2000 amount. How much was that?
[AGENT][NEUTRAL] Yes, OK, so on that particular um.
[AGENT][NEUTRAL] On that particular uh claim, let me just see, I'm just gonna pull that again here. So on the explanation of benefits that showed a, a deductible co-payment or co-insurance of 2000.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] $257.10 but.
[AGENT][NEUTRAL] Because we took out that $250.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] That's why you got less than that. So let me see if I can't find that for you because there's also.
[CUSTOMER][NEUTRAL] It is only $22,0007.10 right?
[AGENT][NEUTRAL] Yeah, yeah, because there's also because there's also a per calendar day maximum for this, so the per calendar day maximum is $2000 but you see we had other claims that came in too.
[AGENT][NEUTRAL] So you, there are a couple of things that happened with this particular claim. First of all, there was, there were other claims for that data service.
[AGENT][NEUTRAL] That came in, they had to be paid first and then they took $250 out of your out of your, your claim for the deductible. So you see there are several things that happened.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Did it.
[AGENT][NEUTRAL] Yeah, that, then that's why you got $1,934.60.
[CUSTOMER][NEUTRAL] OK, so like you had paid $1,934 right?
[AGENT][POSITIVE] Yes, that's right. Um.
[AGENT][NEUTRAL] And let's see, I can find your.
[AGENT][NEUTRAL] You can find your check for that, um.
[AGENT][NEUTRAL] It looks like that went out in the mail.
[AGENT][NEGATIVE] Let's see if I can't uh find it and I apologize for for shouting, but it's like I said, I'm having trouble with my phone.
[AGENT][NEUTRAL] Um, let's see if I can find it here, um.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] And before that, can you help me with the receiving date and uh process it?
[AGENT][NEUTRAL] Yes, yeah, that's what I'm looking at now. So we received your claim on the [PII], and we processed it on [PII]. So we got it on the [PII].
[AGENT][NEUTRAL] We process it on the [PII].
[AGENT][NEUTRAL] And you, we sent out a check, a single paper check.
[AGENT][NEUTRAL] And that check number was 1865144.
[AGENT][NEUTRAL] And it looks like it was cashed on [PII]. So this, this check has been cashed back in August.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so what was the check number 181?
[AGENT][NEUTRAL] Uh yes, it's 186.
[AGENT][NEUTRAL] 5144.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and it was in Gaston?
[AGENT][NEUTRAL] It was casted on [PII].
[AGENT][NEUTRAL] [PII]. Now we send it out on [PII], but it was cashed.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, [PII] [PII] you're saying, right?
[AGENT][NEUTRAL] Um, uh, [PII]. So [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Get it
[CUSTOMER][NEUTRAL] Get it, uh, [PII], can you help me with one more thing? Can you, uh, fax me the EOB?
[AGENT][NEUTRAL] Sure. What, what's your fax number?
[CUSTOMER][NEUTRAL] That would be [PII].
[CUSTOMER][NEUTRAL] 300.
[CUSTOMER][NEUTRAL] 242-3.
[AGENT][NEUTRAL] OK, I'm just gonna read this back to you because you know that said we're having trouble with the phone. [PII]. And do you mind spelling your name for me please so I can send it to your attention?
[CUSTOMER][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Sure. That would be [PII]
[AGENT][POSITIVE] OK, great.
[AGENT][NEUTRAL] OK, I'll have this for you. Is there anything else that
[CUSTOMER][NEUTRAL] And can you help me with the
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Can you help me with the reference number as well, [PII]?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII], and we're gonna use that today's date as our reference.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so today's date will be the reference number, right?
[AGENT][NEUTRAL] That's right. Yeah, today's date is the reference and uh and my name is [PII]
[AGENT][NEUTRAL] And we're gonna use that today's date as our reference.
[CUSTOMER][NEUTRAL] Get it.
[CUSTOMER][POSITIVE] Get it, get it. OK, thank you so much, [PII], for all the information. How much mhm.
[AGENT][POSITIVE] OK, thanks for contacting ATL.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure. And how much time it will take to uh get the fax?
[AGENT][NEUTRAL] Well, it, I should be able to do it here in a couple of minutes. I just need to, I just need to get it, uh, I just need to get it up here and do it. It's.
[AGENT][NEUTRAL] Yeah, I, I would give it a couple of minutes, OK?
[CUSTOMER][POSITIVE] Get it, no worries. I'll wait for it.
[CUSTOMER][POSITIVE] Sure, sure. Take your time. No worries. I'll wait for your fas, OK? Rather than thank you so much all for all the information that I need.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you very much you have a very good day thanks for contacting us.