AccountId: 011433970860
ContactId: fc9772f7-b04d-40e0-af2d-533322c8d4e3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 378820 ms
Total Talk Time (AGENT): 176876 ms
Total Talk Time (CUSTOMER): 88563 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/fc9772f7-b04d-40e0-af2d-533322c8d4e3_20250328T12:56_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. My name is [PII]. I'm calling from Riverview Hospital. Actually, I need to check claim status for one of the members.
[AGENT][NEUTRAL] OK. Did you say that your name is [PII]?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Oh, I am so sorry I misheard you. OK, [PII], you're needing claim status for one member, is that correct?
[CUSTOMER][POSITIVE] Thank you thank.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and what is a good call back number for you please?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] Uh, the policy number is 02518263.
[AGENT][POSITIVE] Thank you one moment please.
[AGENT][NEUTRAL] And call any information that I do provide for you today would be a verification of benefits and not a, mm, not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the date of first [PII] total bill amount for him, please?
[CUSTOMER][NEUTRAL] Uh, it's [PII]. Total bill amount was $3,553 even.
[AGENT][NEUTRAL] OK, so now on this policy, there is no claim on file for this data service. This policy actually did not become active until [PII]. Let me see if there is another policy that he had prior to this, and he did under a different policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, so the policy number that was active at that time was 02369828. It had an effective date of [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And a term date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check to see if that was received.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so, yes, ma'am, that claim was received.
[AGENT][NEUTRAL] The received date was [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The, um, I'm sorry, did I already give you the claim number? I didn't, did I?
[CUSTOMER][NEUTRAL] Uh, is it the 354-5610?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yes, I do have that and then we did receive the EOB but it was denied uh because they were looking for a primary EOB submission and we faxed it on, um, I believe it was on [PII] via fax so I wanted to check status after that. Did you guys receive it and what is the status now on the claim?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct.
[AGENT][NEGATIVE] OK, we, it does not appear that that was received.
[CUSTOMER][NEUTRAL] OK. So just to make sure.
[AGENT][NEUTRAL] It is, it does.
[AGENT][NEUTRAL] Uh-huh. Sure.
[CUSTOMER][NEUTRAL] Uh, the fax number was [PII].
[AGENT][NEUTRAL] No, it is, no, it's, that's close but it should be 8, well, I don't know, you maybe you said this, [PII]. Is that what you said?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes ma'am, that is the correct fax number. It needs to be to put to attention claims department, but no ma'am, we did not receive that for whatever reason.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, I will go ahead and uh refax it. And then is there a timely to fax it between this time frame?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, ma'am. There is, there is not. No, ma'am.
[AGENT][NEUTRAL] And then also [PII] I you're welcome. I don't know if you already have this information, but we also have a portal that you should be able to check claim status in once we have processed the claim, and our portal website is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you for that information.
[AGENT][POSITIVE] Oh, OK. Well, you're certainly very welcome. And again, is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] Uh, is there a call reference number?
[AGENT][POSITIVE] Yes ma'am, you would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] All right, thank you so much. Have a good day.
[AGENT][POSITIVE] Well, you, yes, ma'am, you too, and thank you for calling APL. Have a great weekend as well.
[CUSTOMER][NEUTRAL] Mhm. Bye.