AccountId: 011433970860
ContactId: 09558e7d-d771-43c6-beb3-cf83c812d5af
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 580440 ms
Total Talk Time (AGENT): 154494 ms
Total Talk Time (CUSTOMER): 365019 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/2025/06/12/09558e7d-d771-43c6-beb3-cf83c812d5af_20250612T18:47_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling. I'm trying to find out why you guys denied a claim for me.
[AGENT][NEUTRAL] OK, I can assist you with claims and um may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And may I have the policy number?
[CUSTOMER][NEUTRAL] Um, 02459.
[CUSTOMER][NEUTRAL] 626.
[AGENT][NEUTRAL] Thank you. And for security, may I have your date of birth, mailing address and email address on file, Mr.
[CUSTOMER][NEUTRAL] [PII]. My mailing address is [PII].
[AGENT][NEUTRAL] I see what's the email address? The email.
[CUSTOMER][NEUTRAL] And what else did you want?
[CUSTOMER][NEUTRAL] Oh [PII].
[AGENT][NEUTRAL] OK, thank you. Let me pull the details on that claim. OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I change your shoes.
[CUSTOMER][POSITIVE] And then when she comes back I'll tell her that you're on the phone with me. Yes, perfect. Yeah, and that um we need to find out why.
[CUSTOMER][POSITIVE] Yeah, exactly.
[CUSTOMER][NEGATIVE] Especially if you guys have mailed this 3 times already, what, what is the problem? Exactly.
[CUSTOMER][NEGATIVE] You know, there's just no reason for this.
[CUSTOMER][NEGATIVE] You know, at least now I, I got you to back me up because you know every time I call them they just we never received it and I'm like how can you not have it and now today when I called them and told them you know well wouldn't the claim be the same for both eyes you know but of course not they. Well one says right and one says left and they have a different data service because they were you know different dates that the surgery was done on which is fine um but you know like.
[CUSTOMER][POSITIVE] And we send things electronically through a clearing house, so [PII] was a while ago. Exactly, yeah, you're 100% right.
[CUSTOMER][NEUTRAL] And then, and then seeing the anesthesia bills came later. So that was the other thing I was calling them about, you know, now, aren't they the same, you know, claim? And she says, as long as the data service is the same, then that the claim is the same.
[CUSTOMER][NEGATIVE] So she said we we served everything for September but October we have not or the August when we have not just don't understand it. OK. And then you know, in my opinion, can't they if if they're missing something, why can't they just call you guys direct and get it?
[CUSTOMER][NEGATIVE] You know, why do they mail me a letter and it, you know, and it takes forever to get here and they just they drag out.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][POSITIVE] OK, thank you for holding.
[AGENT][NEUTRAL] And you're calling about the recent claim that we processed on [PII]?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Oh, I don't know what the date is here.
[CUSTOMER][NEUTRAL] Um, on the claim.
[CUSTOMER][NEUTRAL] I know the claim date, but.
[CUSTOMER][NEUTRAL] Yeah. Do you wanna introduce me [PII] so I can help? Yeah. I, I've got Park Nicollet on the phone with me here because we're trying to find out why these claims aren't getting paid. Um, no, I just spoke to somebody from your office earlier today and they said that they had gotten the, the, the diagnosis code for the uh [PII].
[CUSTOMER][NEGATIVE] Um, I, but not for the [PII], and now I've got Park Nicollet on here, and we're trying to figure out why because they've sent this to you guys twice now. And, and you guys are saying that you didn't get it for the [PII] surgery.
[CUSTOMER][NEUTRAL] Can you. Hi, this is [PII] with Park Nicolet and so I'm showing that we sent a claim on [PII] for data service [PII]. I'm told by [PII] that you guys are telling him that you didn't receive the diagnosis codes, but I'm, I'm staring at the claim right now. In fact this is not the 2nd but the 3rd claim we've.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Sent so we sent one on [PII]. We sent another one on [PII], and we've sent yet a third claim on [PII]. It does indicate that it's the right eye and it shows diagnosis code H2181 as well as H2511.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The OK, so this is the care team, um, and this goes to claims department. Let me go ahead and tell you what I got, OK?
[AGENT][NEUTRAL] Um, so, uh, we did receive a claim and we did receive a claim on [PII]. This right here is for the date of service of [PII] for the left.
[AGENT][NEUTRAL] Um, left eye, and this one, does have the information because we did receive the HIXA form. This was sent um by the provider, so we do have the um the 1500 form which it has the information we need.
[AGENT][NEUTRAL] Um, the documents that was received prior, which it was on [PII] and [PII], um, which is the claim for I believe the [PII], was sent directly from the member and what we got is just the regular bill. It was not a 1500 HA form, so it didn't have the diagnosis code and that's why we were asking for the diagnosis code, um, uh.
[CUSTOMER][NEUTRAL] So we have sent the claim though the same way that we sent the [PII] claim to you that went out on [PII] and you're saying you received it [PII], so that's [PII] we're we're looking at the [PII] data service for the right eye and I can see that we have sent 3 claims on on this for the $3,437.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, where are you sending?
[CUSTOMER][NEUTRAL] And we send it the same way each time, so the 3rd claim has been sent, let's go back over here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I show Enovacare [PII].
[AGENT][NEUTRAL] That's not our address.
[CUSTOMER][NEUTRAL] OK, let me go look at the other claim for [PII] and see what address is on there, so bear with me just a moment. I'm determined to help [PII] solve this today. OK, um, alright, on this one I have [PII] [PII]. Is that correct? [PII]?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, I understand.
[AGENT][NEUTRAL] That is the correct address.
[AGENT][POSITIVE] Yes, that is the correct.
[CUSTOMER][NEUTRAL] Alright, we're gonna send you a new claim with the correct address. This is what I'm, I'm here to help [PII] find out why you guys are not receiving those claims. So I will, uh, go ahead and take this back to our internal department. We'll get this claim resent another time to the American Public Health PO box.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. Yes, and we, yes, and we did receive the one for [PII]. OK, so that one is in line to be processed again it was received on [PII], OK?
[CUSTOMER][NEUTRAL] That's all I need to know.
[CUSTOMER][POSITIVE] All right, perfect.
[CUSTOMER][POSITIVE] That's fine. That makes me happy. I got what I want to know. Thank you.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] OK. You're welcome. Is there anything else I may help you with today, Miss [PII] or Mr. [PII]?
[CUSTOMER][NEUTRAL] No, as long as we get this taken care of. I, I, I question. I, I question why the billing address on the back of the card is to [PII], but the claim has to go to [PII]. I mean, that seems like a, a, a big, a big problem on your guys' part.
[AGENT][NEUTRAL] All right. OK.
[CUSTOMER][NEGATIVE] You know, so I, I wish you guys would, yeah, I wish you guys would get that resolved because here we're here we're sending them to the wrong address. That makes no sense. And, and that's the address that you are posting us to send it to on the back of my card.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mr. [PII], is that the is that the APL card because we have no addresses in [PII]. Is that the APL card or what card are you looking into?
[CUSTOMER][NEUTRAL] I don't know, it's the, it's the one that I use when I go to the doctor's office. I can tell you that.
[AGENT][NEUTRAL] Uh, the business workers of America card, that's not gonna have our address, that's gonna have their address and that, that, that is not where the uh the claims goes to.
[AGENT][NEUTRAL] That is a different card.
[CUSTOMER][NEUTRAL] OK, well, whatever as long as this gets resolved.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. OK, is there anything else I may help you with today, Mr. [PII]?
[CUSTOMER][NEGATIVE] No that works for me.
[AGENT][POSITIVE] OK, have a good day and thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] My pleasure.
[AGENT][NEUTRAL] Right.