AccountId: 011433970860
ContactId: 4dd585d6-c364-4906-ba6e-355e33931c26
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 759940 ms
Total Talk Time (AGENT): 375250 ms
Total Talk Time (CUSTOMER): 113937 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/4dd585d6-c364-4906-ba6e-355e33931c26_20250428T22:02_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling about a claim that I've had to submit a lot of paperwork for to see if hopefully the last thing I submitted today will get this claim paid.
[AGENT][NEUTRAL] OK, yes, so I can certainly look that that up. And [PII], what is your policy number, please?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] My policy number.
[CUSTOMER][NEUTRAL] It's 240-573-9.
[AGENT][NEUTRAL] Thank you. I could just verify your um last name and date of birth, and a phone number, please, while I look that up. I just wanna make sure I get the right policy.
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII]. Phone number you said [PII].
[AGENT][NEUTRAL] Thank you. Now, is the claim for you or for a member of your family?
[CUSTOMER][NEUTRAL] For my son.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is it for Keenan or?
[CUSTOMER][NEUTRAL] Yes, it's for Keenan.
[AGENT][NEUTRAL] OK, OK. Thank you. Let me see what we have here.
[AGENT][NEUTRAL] Is there a particular date of service that I needed to look for or?
[CUSTOMER][NEUTRAL] Yeah, it's just one just one claim.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] [PII]. OK, so, so this is a facility bill. OK, let's see.
[AGENT][NEUTRAL] So it looks like what they're asking for is your is your explanation of benefits and let's see.
[CUSTOMER][NEUTRAL] Um, explanation of benefits was sent on.
[CUSTOMER][NEUTRAL] I believe that either the [PII] or the [PII] of this month.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, certainly, let me see what we've got here.
[AGENT][NEUTRAL] OK, so it looks like we received something today, so let's see what we've got.
[AGENT][NEUTRAL] I apologize my computer is just a little bit slow, but we'll see, trying to pull it up.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] The emergency room.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, excuse me just one moment please. I'll be right back. Excuse me just one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, so what we're looking for is the explanation of benefits from your major medical. Um, so let's
[CUSTOMER][NEUTRAL] I sent that weeks ago.
[AGENT][NEUTRAL] OK. Well, what I've got.
[CUSTOMER][NEUTRAL] That's there and then and then once I sent that in, they asked me to send a bill so I sent a bill in and then once I sent the bill in they asked me for something with codes on it so I've now sent that in.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And when I pull up my account, I see all that's there.
[AGENT][NEUTRAL] Or
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, explanation of benefits were sent over on the [PII].
[CUSTOMER][NEUTRAL] I'm sorry, the [PII].
[AGENT][NEUTRAL] The [PII], OK.
[AGENT][NEUTRAL] I see this is, I'm just going through all the submissions and that's I'm just looking for it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] So certainly the, the uh the um bill from the hospital came through uh clearly, so that's not a problem. um.
[CUSTOMER][NEUTRAL] I think it's a total of 6 different explanations of benefits that I was on the [PII].
[AGENT][NEGATIVE] So so far what I'm just telling you what I've seen so far, I, I've seen where you, you received a bill um in the mail, uh for this. I see, uh, and what I've gotten so far is, um, what I'm looking at so far. I'm just going through everything that was, no, I have something from Centara and that's the, that's the bill, so that's not what we're looking for. Um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, but they said
[CUSTOMER][NEUTRAL] Yeah, they said the bill wouldn't work so we had to go back and get some detailed billing something where they billed the insurance in the hospital.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] What I'm looking for is is something from from uh Aetna and that's what, let's see, and I, and I'm just going to, as I say, I'm just going through everything. I just wanna make sure while we're on the phone that I do have everything that I need so.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] I have the confirmation number for the Aetna stuff if that helps you find it.
[AGENT][NEUTRAL] Oh, I think I found it. I'm looking, I think I'm.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] So this is [PII].
[AGENT][NEUTRAL] We have a ER bill.
[AGENT][NEUTRAL] OK, so there's that.
[AGENT][NEUTRAL] And on the other documents, it looks like it has the, the diagnosis code which is, you know, the other thing that we'd be looking for.
[AGENT][NEUTRAL] OK, so there's that.
[AGENT][NEUTRAL] Is that
[AGENT][NEUTRAL] OK. Uh, so far, it looks like we've got everything. I just want to be absolutely certain, um.
[AGENT][NEUTRAL] I, I found this the what I was looking for from Aetna. That's, that's the main thing that I was looking for, so that's.
[AGENT][NEUTRAL] Just to make sure that we've got that. OK, so it does look like we have everything to, to finish, uh, finish up the bill, but the, the, um, the paperwork from the, from the hospital it's called the UB form and we weren't able to read that, but, um.
[AGENT][NEUTRAL] Uh, no, this should be fine. Uh, so it does look like we have everything. So what we're going to do is, uh, we will go ahead and combine all the, all the paperwork, uh, that you've sent, um, and then we can go ahead and finish uh paying that. Now, for, uh, outpatient services.
[AGENT][NEUTRAL] Your policy um pays up to $500 for um outpatient services and so that's what we will, we will go ahead and and uh look at uh paying, so, um.
[AGENT][NEUTRAL] Yeah, so it looks like we've gotten everything uh we just need to put all the paperwork together. It's just kind of, it's, it's in different, different, um, submissions. So what we need to do now is now that we have a legible copy of the, of the hospital uh bill with the codes, um, then we just need to go ahead and, and put everything together. Now, normally, um, it takes us about 7 to 10 business days, if not less, to process that, um, and, uh, let's see.
[AGENT][NEUTRAL] Oops
[AGENT][NEUTRAL] OK, I see that you have turned in a direct deposit, which is great. So I would be, I would just be looking for that because it does look like we have uh everything that we need. I'm [PII], so this, uh, this looks like we can go ahead and finish this. Now, do we have any other claims that we're looking at um for uh any of your uh yourself or for your children? This is, is this it that we are the only one that we're looking for?
[AGENT][NEUTRAL] Is the one for [PII]?
[CUSTOMER][POSITIVE] Yeah, this is it, yeah, just, just trying to bring this one to the finish line.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, I think we've done it so uh yes so I think we've gotten everything. I do appreciate it so um.
[AGENT][NEUTRAL] Yeah, it's, it looks like uh
[AGENT][NEUTRAL] It looks like we have the codes, we have the uh explanation of benefits, and usually whenever we turn in, uh, or whenever you're, you're submitting a claim, that's what we're looking for we've, if we can get that coding that was like on the UB form that tells, uh, you know, the, the bill, the, the, uh, what was done, and then your Aetna pay uh documents, that's what we're looking for and so um.
[AGENT][NEUTRAL] It does look like we have this for the [PII] ER visit. There also there also looks like there's multiple um uh bills for um the physicians that he saw. So what we'll do is we will go ahead and uh address everything.
[CUSTOMER][NEUTRAL] And he had he had surgery.
[AGENT][NEUTRAL] Yes. Yeah.
[CUSTOMER][NEUTRAL] Yeah, it wasn't just the ER because he had a whole surgery.
[AGENT][NEUTRAL] So, what we will do is um we have to, we have to address all of that in our uh in our claim. And so we'll go through every uh charge that we have for him, um, for everything, the pathology, I'm looking at the pathology report here, um, or claim. And so, uh, it's, that is what you will, you will see on your, uh, on your ER like for the anesthesia I see for the surgery that he had.
[AGENT][NEUTRAL] Uh, abdominal surgery. And so that is, that's all going to be on that claim, but it, it does look like we have everything that we need. So, um, that should be fine. Um.
[CUSTOMER][NEUTRAL] But still it's a it's just one, but it's just like one benefit paid out right doesn't matter that he was in the ER in the hospital. It's just $1500 that's it.
[AGENT][NEUTRAL] That's correct, yes, yes, that is correct. Yeah, that's, that's what it is, but, um, but yes, it's, it's all there, um, so does look like we, we have it, um, and so you should be hearing from us, as I say, it usually takes 6 to 10 business days. Um, we're actually working on the uh on the claims, uh, from, from this latter part of the month, and so you should be hearing from us just any time.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Um, but as I mentioned before, since you have that direct deposit, that always is is very helpful. So you, you'll just hear from us that much sooner and of course you will be getting something in the mail as well as your direct deposit.
[CUSTOMER][POSITIVE] All right thank you.
[AGENT][NEUTRAL] OK, well, [PII], thank you for contacting AT.