AccountId: 011433970860
ContactId: 51446c6f-f3aa-4a0d-8628-81d4348924c0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 389260 ms
Total Talk Time (AGENT): 137937 ms
Total Talk Time (CUSTOMER): 128818 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/51446c6f-f3aa-4a0d-8628-81d4348924c0_20250424T17:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling with Prisma Help. How are you?
[AGENT][NEUTRAL] Doing well, [PII] how are you?
[CUSTOMER][POSITIVE] I'm good thank you. May I get the spelling of your name?
[AGENT][NEUTRAL] Sure, it's [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII] Thank you so much. Can you help me with claim status?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Absolutely I can check on a claim for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Of course [PII] and that is a direct line.
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I do. The first one is 01701610, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, uh, did you have [PII]'s date of birth?
[CUSTOMER][NEUTRAL] I do. [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] This particular claim is [PII].
[CUSTOMER][NEUTRAL] Billed amount on this one is $168 plus $439 total.
[AGENT][NEUTRAL] Oh, OK, 4:39 total. OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, well, I will say, um, [PII]'s, this policy terminated [PII]. Um, do you still want me to check, uh, to see if this claim has been received?
[CUSTOMER][NEUTRAL] If you don't mind, and do you show a replacement policy by chance?
[AGENT][NEUTRAL] Of course, yeah, one moment.
[AGENT][NEUTRAL] No, I did just check to see if she had one active at that time and she did not. This was the only one that she had with us.
[CUSTOMER][NEUTRAL] OK. And you said it was [PII]?
[AGENT][NEUTRAL] OK, um,
[AGENT][NEGATIVE] Yes, and I'm also not showing that we have received this claim.
[AGENT][NEUTRAL] Last time we received for this member was for [PII].
[CUSTOMER][NEUTRAL] Alright, let me get this corrected here.
[CUSTOMER][NEUTRAL] I'm just updating this coverage, give me just a moment.
[AGENT][POSITIVE] Oh, you're fine. I'm doing my notes too. No worries.
[CUSTOMER][NEUTRAL] Let's see, look at one other thing.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um, do you still have her pulled up?
[AGENT][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] OK, do you show Cigna Great [PII] is her primary?
[AGENT][NEUTRAL] Um, I don't know, since this terminated in [PII], um.
[AGENT][NEUTRAL] I'm not sure any of that would be accurate.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] And what is the reference on this.
[CUSTOMER][NEUTRAL] Patient.
[AGENT][NEUTRAL] Uh, reference number would be the same for all of them. Uh, that would be my first name, last initial, and today's date. Uh, so my last initial is A.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, give me just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I do have another one.
[CUSTOMER][NEUTRAL] Whenever you're ready.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I'm ready when you are.
[CUSTOMER][NEUTRAL] OK, it is going to be 01807645.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for this number, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Perfect. Uh, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] This one is going to be $228.25 $168.
[AGENT][NEUTRAL] Got it. OK, and this one is active, so give me just a moment, let me see if we received this one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] I'm sorry, that was, uh, you said 228 of 25, correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so no, we have not received a claim for that date of service.
[AGENT][NEUTRAL] But she was active at that time, so you can, yes, go ahead.
[CUSTOMER][NEUTRAL] OK, now let me ask you.
[CUSTOMER][NEUTRAL] Um, would you be a primary to, to Aetna or a secondary?
[AGENT][NEUTRAL] No, no, this is definitely a secondary medical policy. So it's designed to help with co-pay, deductible and co-insurance and is very dependent on major medical. So whoever she has as her primary does have to pay before this policy can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright. That looks like that might be the issue. Let me see.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah, it looks like it was not sent to the primary first.
[AGENT][NEUTRAL] Oh, I see.
[CUSTOMER][NEUTRAL] Yeah, so it needs to go to Aetna and then it will go to you guys.
[AGENT][NEGATIVE] Yeah, and there's no timely filing limit, so.
[CUSTOMER][POSITIVE] Alright, I'll get this one out to Aetna.
[AGENT][NEUTRAL] Yeah, that's perfectly fine whenever you're able to, uh, did you need um we've got a mailing address fax number and a payer ID if you needed any of that.
[CUSTOMER][NEUTRAL] Um, no, I've got it.
[AGENT][NEUTRAL] OK, right, was there anything else I could help you with [PII]?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] That's it. You have a good day.
[AGENT][POSITIVE] Alright, thanks for calling APL you too bye bye.
[CUSTOMER][POSITIVE] Thank you bye bye.