AccountId: 011433970860
ContactId: 395aecda-a3c4-441a-ac59-ab97f0f79704
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 455500 ms
Total Talk Time (AGENT): 108089 ms
Total Talk Time (CUSTOMER): 218154 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/395aecda-a3c4-441a-ac59-ab97f0f79704_20250331T15:17_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from a provider's office. I write spine and joint. Um, I've spoken to somebody, I want to say maybe about a month and a half ago in regards to, um, you guys were requesting, um, some documentation from the primary provider, and I just wanted to make sure that you guys got all of that and um I wanted to make sure that you they're processing the claims in order to pay them.
[AGENT][NEUTRAL] OK, yeah, let's take a look. Absolutely, [PII]. Do you have their policy number?
[CUSTOMER][NEUTRAL] I do. Give me, give me just one second if I could place you on a brief hold, um, I'll look up that for you. Give me one moment.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] No worries. Yeah, go ahead.
[CUSTOMER][POSITIVE] OK, I'm sorry about that. Um,
[AGENT][POSITIVE] No, no worries.
[CUSTOMER][NEUTRAL] The policy number I have is 02027848.
[AGENT][NEUTRAL] OK, let me pull this up here.
[CUSTOMER][NEUTRAL] Patient's name is [PII]
[AGENT][NEUTRAL] All right, and then just date of birth?
[CUSTOMER][NEUTRAL] His date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was the date of service?
[CUSTOMER][NEUTRAL] So there were a couple dates um that we submitted as a secondary. Give me one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you need me to give you a specific or should I give you a date range?
[AGENT][NEUTRAL] Yeah, let's, I mean, let's start with if you have a specific one, let's start there to see if I can find if they've gotten anything for it.
[CUSTOMER][NEUTRAL] OK, no problem. um, [PII].
[AGENT][NEUTRAL] OK. And then uh.
[AGENT][NEUTRAL] What was the billed amount for that date? Do you have that?
[CUSTOMER][NEUTRAL] Yes, the bill amount was 418.
[AGENT][NEUTRAL] And then what was the amount after the primary?
[CUSTOMER][NEUTRAL] So Aetna, it was, I believe it was $60 they allowed $66.79. They paid $6.79 and left $60 as part of the patient's co-pay 20% co-insurance or something like that.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] So this one doesn't show that we ever got an explanation of benefits for it.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I mean, is the [PII] OK 7 you know, [PII], is that where we should be sending it?
[AGENT][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I don't, I really, I think we've tried twice now and it's just I don't know if we're not sending it with maybe a HICA and it's not getting put with the file, um, because I think we've tried both ways but um.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I can give you.
[CUSTOMER][NEUTRAL] Yeah, so
[AGENT][NEUTRAL] Um, I mean, we have a payer ID. I don't know if you guys have that, and then we also have a fax, but I'm looking through here and
[AGENT][NEUTRAL] I don't, cause usually it'll say other insurance EOB and I'm just not seeing any.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] OK, well, I mean, we, we don't send claims electronic. That's probably also one of the issues. It was sent to Aetna, no paper, um, because we don't really do this a lot. We're mostly personal injury, you know, workers' comp.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, so like we sent it to Aetna paper as a favor to the, you know, the patient, and then they applied whatever they applied and then thought that Aetna, you know, the guy was like, oh no, Aetna's gonna send it over. So then we didn't really do anything with it and then he was upset when he got a bill like a year ago and we were like, well, we have a balance here. I have a secondary, and I'm like, OK. So then he gave us the American public information and then we just sent over thoseICAs.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And then somebody called me earlier last year or the end of last year and was like, oh we didn't get any of Aetna's EOBs and I'm like, OK, so then I'm trying, you know, I'm just trying to do the but like it doesn't seem to like we're sending it the right way maybe normally you guys are used to electronic and maybe it's just not getting put in the right area so I mean I'll try and fax it this time, you know, because maybe that'll be easier but I don't know.
[AGENT][NEUTRAL] OK. Yeah, no, absolutely. Do you need the fax number?
[CUSTOMER][POSITIVE] Yeah, if you could give that to me, I'd appreciate it.
[AGENT][NEUTRAL] Yeah, absolutely. So the fax number is 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll, I'll try and send them just with like the HIFA, not even the note and just the uh the EOB for Aetna right behind it. So hopefully, you know, it'll, they'll you guys will receive it and then normally if it says by fax about how long does it take for it to upload into you guys' system.
[AGENT][NEUTRAL] We should see it uploaded within 24 hours, so I would say if you want to check on it by tomorrow, we should, we should have something.
[CUSTOMER][POSITIVE] OK, I appreciate that. I'll do that. I'm sorry, what was your name again?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, no worries. My name is [PII], that's [PII]
[CUSTOMER][POSITIVE] OK. All right, [PII], I'll go ahead and do that now. Thank you. I appreciate your time.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.