AccountId: 011433970860
ContactId: 1c3d23a5-fba3-4cc0-a51f-9ba952dc608d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 808010 ms
Total Talk Time (AGENT): 252046 ms
Total Talk Time (CUSTOMER): 506279 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/1c3d23a5-fba3-4cc0-a51f-9ba952dc608d_20250319T19:16_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, did, yeah, I'm sorry, could you say your name again?
[AGENT][NEUTRAL] Um, it's [PII], um, it's spelled [PII] Uh-huh.
[CUSTOMER][POSITIVE] It's beautiful. [PII], at first I thought you said easy, and I was like, wow, what a cool name, um, but beautiful, beautiful name. Sorry about that. Um, hi, my name is [PII]. I have coverage with you through my husband's um, employment, and his name is [PII]. I don't know if that's important or not, but let me just tell you what my questions are, and then, um.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Hopefully you can direct me or help me figure out what to do. So I have two bills that I keep well is that a good way to start?
[AGENT][NEUTRAL] Yes, ma'am. That's fine.
[CUSTOMER][NEUTRAL] Uh, OK, OK, um, OK, so I have two bills in front of me, one that has been like it's over, it's like 2 years old and I have, I've called about this and I maybe it's not quite that. I'm trying to remember when the appointment even was. I'm looking to, oh yeah, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] It was no.
[CUSTOMER][NEUTRAL] I'm trying to remember where and when it was. So, but it was for like a colonoscopy um over a year ago.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, and, and I, I, I keep getting this bill, it's now $210 but I remind them that I have this, uh, you know, additional supplemental coverage with you guys. I wanna know, did anybody reach out to you and is there a reason why this bill keeps coming back to me and should I.
[CUSTOMER][NEUTRAL] What, what, what would you recommend that I do? That's one. The second one is a similar situation for something that just happened within the last month where I had a month or two. Now I may have been back in December. I don't know, but I had a um a mammogram.
[CUSTOMER][NEGATIVE] It was, it, it showed suspicious they did an ultrasound uh following and then um something else like a breast thomisthesis. I don't even know what that is, but they, um, and now I'm getting a very large bill from them and I'm thinking again, did they submit this to you all even though I gave them the information on the supplemental coverage was that?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Was it directed to you? Should I be contacting them? Should I contact you? I really just don't know. So any advice you can give me would be helpful.
[AGENT][NEUTRAL] OK. Sure, [PII]. First, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And what's the policy number?
[CUSTOMER][NEUTRAL] Um, I have, I have a group number and I have in hospitals benefit cert number or outpatient benefit cert number. So which of these three numbers are you looking for? None of them says policy number and then there's a payer ID number.
[AGENT][NEUTRAL] Um, the outpatient, yeah, the outpatient er number, that's the policy number.
[CUSTOMER][NEUTRAL] OK, um, so that's 02595727 M like Mary, L like Linda and the number 8.
[AGENT][NEUTRAL] OK. And please verify your husband's name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII] and his date of birth is [PII].
[AGENT][NEUTRAL] OK. And please verify your name again and your date of birth.
[CUSTOMER][NEUTRAL] Sure, it's [PII] and my date of birth is [PII].
[AGENT][NEUTRAL] OK. And please verify your mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII] and I have your policy pulled up and I'm not showing any claims on file, so we haven't received any claims from those providers. Your policy is active and there is no um there's no timely filing limit. So even for the service um that you had last year, well, let me see when was your effective date. When was the
[AGENT][NEUTRAL] OK. Yes, ma'am. I'm showing that the effective date was [PII]. So, um, whatever services you have as far as back as, as far as [PII], claims can be submitted and reviewed um for payment. So what you would, it sounds like what you would need to do is um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give your providers our phone number and the policy number, that outpatient certificate number you just gave me, and have them to call us to verify your benefits. And if they're not familiar with us, um we can also explain to them how to submit claims to us. But most providers are familiar with us. Just let them know that you have secondary gap insurance coverage again and give them the policy number and our phone number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Secondary gap coverage. OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, APL, OK, and then give him this number that I just called, right? This is, um, the number from the card which is the [PII]. And alright, so just so you know.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] No, I did that with this first one, the gastrohealth, the colonoscopy, and the person that I spoke with who I gave you all of this information to said, OK, yes, it will be taken care of. You won't get any more bills after [PII] of this year. So I waited until [PII] and because I continue to get paper things in the mail and I continue to get emails about they're gonna turn me over to collections and blah blah blah and I'm like.
[CUSTOMER][NEUTRAL] Wait a minute. The guy said it was gonna be done. Well, don't you know I got another email today, so I, I just don't know what to do to get the, like, you know, I, I'm talking to people at their company.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] That they're they're supposed to be handling this and they're not so what and given that information what should I be doing?
[AGENT][NEUTRAL] OK, and you said that service, it was for last year it was for a service that took place last year?
[CUSTOMER][NEGATIVE] Yeah, I, well, I think so I know you paid, I mean, well, I know you paid a big portion of it. Somebody paid a big portion of it because I remember when I first, when they first booked it, they told me it was gonna be like $1500 and I said oh no way I'm not gonna pay. I don't wanna have this procedure anyway and I'm certainly not gonna pay that much money for it and that's when [PII] reminded me we had the the coverage, um, so somebody has paid something towards this.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, and this took place in June, right?
[CUSTOMER][POSITIVE] Yes, that sounds right, yeah.
[AGENT][NEUTRAL] Was it in June? OK, yes, ma'am. I, I do show um to the hospital, we did cover um $1120 to the hospital. And then, let's see, for the anesthesia charge, we covered $372.31.
[AGENT][NEUTRAL] And yeah, that's what we paid um so far for that, for that amount and.
[CUSTOMER][NEUTRAL] So I wonder what this, this, this latest thing is it said it was total bill was $358 provider adjusted $98. I paid $50 I guess when I was there I paid a $50 copay or something and it says total due is $210.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let's see, and who's the provider? I'll let you know if one of these providers that I've already paid.
[CUSTOMER][NEUTRAL] It says
[CUSTOMER][NEUTRAL] It says Gastrohealth.
[AGENT][NEUTRAL] OK. And what's the date of service?
[CUSTOMER][NEUTRAL] Uh, and the doctor's name is um uh [PII] The date of service, this is [PII].
[CUSTOMER][NEGATIVE] But I don't know. I mean that makes no sense for an appointment that was in June, right?
[AGENT][NEUTRAL] Right, and I'm not showing any claims on file for [PII].
[CUSTOMER][NEUTRAL] Oh, and, but you know, I know what this was. This was the prep. This was the visit that I went to him before where he scheduled the, the colonoscopy.
[AGENT][NEUTRAL] Right
[CUSTOMER][NEGATIVE] I'll bet you that's what this was because then I had to cancel. I had to reschedule the colonoscopy twice and that's why I got pushed out to June. It should have, I think it originally was supposed to be like in February or something and then it got pushed out a couple of months and then it got pushed out again.
[CUSTOMER][NEUTRAL] That's exactly that so this is from the office visit.
[AGENT][NEUTRAL] OK. We
[AGENT][NEUTRAL] OK, and it was for um date that was in [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I can see if you still have any benefits remaining.
[AGENT][NEUTRAL] Oh, yes, ma'am. You have the full 1500 available for [PII]. So yes, they can resubmit the claim or submit it because we never received it the first time, so.
[CUSTOMER][NEUTRAL] So I think what I'm gonna do is call the office because this person that I talked to who said they were gonna take care of it obviously didn't take care of it so because if you don't have any claimsing then then and it hasn't been paid in full then it shouldn't even I should yeah, I, I'm gonna call the office now that I can now I piece this together a little bit better.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so that takes care of that first one. What do you and so the second one I should go back to the provider just like we're talking about now because I didn't do that and and remind them that I gave them that supplemental coverage and see if they've submitted it to you or what they what remind them they need to submit it to you and give them that information again, right? That's what, OK, alright.
[AGENT][POSITIVE] Yes ma'am. Yes ma'am.
[AGENT][NEUTRAL] And I can also give you our fax number um to let them know that they can um file the claim with us through fax.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, it's is that the [PII]?
[AGENT][NEUTRAL] Yes, ma'am, and just let them know to attention the claims will need the claim and we'll need the EOB from your primary insurance company for the date of service. They can fax that to us and attention it to the claims department.
[CUSTOMER][NEUTRAL] OK, wait, that, OK, I need, I'm gonna need you to say that again. I'm sorry it's so.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] So when I call about this mammogram.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Call provider.
[CUSTOMER][NEUTRAL] You're saying give them um both the phone number and the fax number and tell them they can send send the claim by fax, r[PII]?
[AGENT][POSITIVE] That's correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] But, uh, and I'm, I'm also giving them my, um, policy number, right?
[AGENT][NEUTRAL] Right, give them the new policy number. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Excuse me, and then then you said something else and claims, um, tell send claim by fax.
[CUSTOMER][NEUTRAL] And include.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Or, or, or attention, uh make attention to who do we, who do they make it.
[AGENT][NEUTRAL] the claims department.
[CUSTOMER][NEUTRAL] To claims department OK and then and what should they include? I, I didn't catch.
[AGENT][NEUTRAL] OK, they should include the claim form.
[AGENT][POSITIVE] And they should include, yes, ma'am.
[CUSTOMER][NEUTRAL] Claim form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And they should include the they should include the explanation of benefits from your primary insurance company.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] From primary insurance company, OK, anything else?
[AGENT][NEUTRAL] Right, for the, for the date of service.
[CUSTOMER][NEUTRAL] 4 date of service, OK, got it.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, um, anything else that I don't know I should be asking?
[AGENT][NEUTRAL] Um, no, ma'am. If they get that sent to us, we should be able to get the claim processed and paid for you. Um, just, just know that we cover up to, it sounds like it will be for an outpatient service. So for outpatient, we cover up to $1000 per calendar year. I'm not sure how much your bill is, but um we'll only cover up to $1000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, it's $810.
[AGENT][NEUTRAL] OK. OK. Yeah, so it'll be covered.
[CUSTOMER][POSITIVE] OK, so it should be covered. OK, very good. All right. [PII], you made that very easy, and I appreciate it.
[AGENT][POSITIVE] All right, thank you, [PII]. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] No, no, uh, I'm gonna make these next couple calls and hopefully put this behind me.
[AGENT][POSITIVE] OK. Well, [PII], thank you for calling ATL. You have a great rest of your day. Bye.
[CUSTOMER][POSITIVE] You too thank you very much bye bye.
[AGENT][POSITIVE] Mhm. You're welcome.