AccountId: 011433970860
ContactId: 42cb8937-697a-422d-be4b-15a791684499
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 551119 ms
Total Talk Time (AGENT): 355590 ms
Total Talk Time (CUSTOMER): 162776 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/42cb8937-697a-422d-be4b-15a791684499_20250121T21:05_UTC.wav
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[AGENT][NEUTRAL] Contacting HTL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I wonder if you might be able to. I have a question uh regarding an explanation of benefits I received.
[AGENT][POSITIVE] Yes, sir. I'd be glad to do that. What is the, the uh policy number, please?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Policy number is 02516003.
[AGENT][NEUTRAL] Thank you. And if I could verify your name, date of birth, and a phone number, please, sir.
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] And actually, you know what? I, I realized that I, that policy number I gave you was the one on the form that I can that came back, but I have a different policy number on my APL card.
[CUSTOMER][NEUTRAL] Which, which might be the cause of this problem.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Um, did, I'm sorry, you wanted to.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] That number would be fine, yes.
[CUSTOMER][NEUTRAL] OK, 01369753.
[AGENT][POSITIVE] OK, thank you very much. And I'm sorry, so you were gonna give me your phone number?
[CUSTOMER][NEUTRAL] Phone number is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. Let me see what I've got here.
[AGENT][NEUTRAL] So the explanation of benefits that you received, um,
[AGENT][NEUTRAL] What is the, is this for you? Is this for your wife?
[CUSTOMER][NEUTRAL] My wife, [PII]
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] I see this is
[CUSTOMER][NEUTRAL] And there's a claim number here on the form too.
[AGENT][NEUTRAL] Does it end in 2443?
[AGENT][NEUTRAL] The claim number?
[CUSTOMER][NEUTRAL] The claim number? No, no, it's 353550825.
[AGENT][NEUTRAL] Yes, OK, what is the claim number?
[AGENT][POSITIVE] OK, thank you. Let's see we've got here.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, Galway Anesthesia Associates.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, what has happened is there were normally whenever we have one policy that has lapsed and another one that has uh gone into effect, there's usually uh they usually link up together. I don't think that that's what's happened here, but let me just check.
[AGENT][NEUTRAL] OK, so the current policy that you have with us, sir, if, if I'm correct.
[AGENT][NEUTRAL] Went into effect on [PII] and it is active. This involves you and your wife. Um, it looks like your daughter's aged out of the plan. Does that sound right to you?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so, um, I do apologize for the, uh, for that. What I'd like to do with your permission is I'd like to have this sent back, and then what we can do is it will be attached to the, the current policy you have the policy number, uh, ending in 6003, we're showing that it's lapsed and that's probably why they received, um, uh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The notification that your policy was no longer active. So we'll need to get in touch with Galway and let them know that that is, that that has changed. Now, let me um let me just pull up the uh
[AGENT][NEUTRAL] The claim itself and then we can see what has been turned in on that.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I think that's just what has happened here is that it just didn't normally what they'll do is they'll sync up with all the all the policies in this case I don't know why, but let's look at this and see, yeah, so we have something.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, and this actually had happened.
[CUSTOMER][NEGATIVE] That happened when, when she went for the procedure, they told us, oh, this policy is expired, terminated, and I, I got this right number and I, I called APL and they said, oh no, no, there's a mistake and, you know, I called the center back and OK, we're updating it and so I thought this was resolved.
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] Did you get a new card, um, [PII], did you get a new card from us?
[AGENT][NEUTRAL] Uh, from that shows there.
[CUSTOMER][NEUTRAL] Well, I, I have a card that says effective date [PII].
[CUSTOMER][NEGATIVE] But it does not have a policy number on it.
[CUSTOMER][NEUTRAL] I wrote the policy number on it because we called up and I was able to get the policy number based on the group number and the payer ID number and they gave me the policy number that's that's the number ending 9753 that I gave you.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] If, if you don't mind verifying your email address for me please, I'd like to send you the most updated card.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Sure, you can send it to [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. Um, so let me go ahead and do that. Uh.
[AGENT][NEUTRAL] Yeah, for whatever reason, it's, it's just not, it's just not syncing up, and I, I could not tell you why. Um, now it looks like your, uh, adjustments here from, from, uh, Cigna is that we would be paying $419.77 and that would go to Galway, um.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] For Doc Doctor [PII]?
[AGENT][NEUTRAL] For data service 12-182024. So let me go ahead and uh and um send this uh back um and have this uh reissued uh and get it paid, and then what we can do is um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Uh, get that taken care of, but in the meantime, uh, what I'd like to do is send you your most current, uh, policy, which ends in the, um,
[AGENT][NEUTRAL] 753, I think, uh 0136.
[AGENT][NEUTRAL] 9753.
[CUSTOMER][NEUTRAL] Right, 753, yeah.
[AGENT][NEUTRAL] OK, that way we won't go back.
[CUSTOMER][NEUTRAL] OK, and now you said that APL would pay how much?
[AGENT][NEUTRAL] Well, it looks like what your, uh, what Cigna is asking is, uh, it looks like from your co-payment, your deductible, excuse me, is $419.77. So the billed amount was $3,045. Cigna made an adjustment of 26, 25. 23 cents.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Which leaves the remaining balance of $419.77. Now, whenever, um this is usually the agreed upon amount between your insurance company and the provider, uh, when they, whenever they make that adjustment amount, um, and then whatever is left over, uh, the $419.77 is what the provider, uh, can reasonably expect from the normally it would be your out of pocket. So that is what we're showing here, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is what will be paid to Galway. Now, does look like there's another, um, I will go back through here and we'll see about all the claims that are that are listed on here, but uh I would like, I'd like before you send it, before you use the card again so we could get you to the, the right card, um.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just in case this for whatever reason, this, this is not syncing up that way we don't keep having this problem over and over and over again. Um, so let me, let me get this to you, uh, excuse me just a second here. [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] See if I can pull it up.
[AGENT][NEUTRAL] OK, you should be receiving that in the next couple of minutes. Uh, if you don't, um, get it, then please let us know. It will be in a secured email. Um, it will show that it is an ID card. Uh, it's, uh, and you can also go online and print this on our website, [PII]. And what you'll see on that, sir, is that it's uh um employee and spouse. It will show your group number. It will show that it went into effect in [PII], um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] But it's, uh, but it's for you and your wife and it will have the, the correct number and you'll see that um where it says in-hospital benefit or outpatient hospital benefits. So let me get that to you. Now, is there anything else that I may help with while we're on the phone?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, I don't think so, not at this time thank you.
[AGENT][POSITIVE] OK. OK. Well, thank you very much for contacting ATL. If you do have any que yes, sir. Uh.
[CUSTOMER][NEUTRAL] And, and
[CUSTOMER][NEUTRAL] Just so I write it down so I have it, you said I could also get this card at [PII] What was the whole.
[AGENT][NEUTRAL] It, it, yes, sir. It's um the word secured with a D.
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] [PII]. So it's the word [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If I don't see this then I will go to that site to see about getting it.
[AGENT][POSITIVE] OK, you, I'm sending it to you now, so if you do have any questions, just let us know. Um, otherwise, thank you very much for contacting ATL. We'll try and get this resolved as quickly as possible.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you sir. Thank you for contacting API.