AccountId: 011433970860
ContactId: 5b158fb8-e346-4083-a31b-e31780207881
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 396410 ms
Total Talk Time (AGENT): 154132 ms
Total Talk Time (CUSTOMER): 194328 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/5b158fb8-e346-4083-a31b-e31780207881_20250116T16:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, hello. This is [PII]. Um, I wonder if you could help me. Um, may I give you, let's see, what do you need? You need my uh policy number or?
[AGENT][POSITIVE] Yes, yes, please.
[CUSTOMER][POSITIVE] OK great thank you. I'm so sorry I didn't catch your first name my apology.
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] On you.
[CUSTOMER][POSITIVE] Great, [PII]. Thank you so much. It's uh 215-0207.
[AGENT][NEUTRAL] And what's a good phone number for you in case we're disconnected [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you ma'am.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And if you can verify your date of birth and your mailing address?
[CUSTOMER][NEUTRAL] Certainly, uh, [PII]. I live at [PII].
[AGENT][NEUTRAL] And your email address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right. Thank you for that information. And how can I help you today, [PII]?
[CUSTOMER][NEUTRAL] I have two questions for you. The first one is that I, I've submitted all the information I think I needed to. I mean the, the application, um, the verification that shows that I made a payment.
[CUSTOMER][NEUTRAL] Um, the notification from the, the place where the procedure, it was a, uh, an endoscopy, um, where the endoscopy was conducted, um, that shows that I did indeed make the payment. I, I just wanna know if maybe um
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Somebody can just take a quick look, glance and see, do I need anything else or?
[AGENT][NEUTRAL] OK, let me take a look.
[CUSTOMER][POSITIVE] I do appreciate it thank you ma'am.
[AGENT][NEUTRAL] OK, so did you, what did you upload?
[AGENT][NEUTRAL] Because you, there's 1234567 different uploads. So did you upload the itemized bill?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] With the diagnosis code and procedure codes?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, yes, uh, this is what I received from the digestive.
[CUSTOMER][NEUTRAL] Um, company, and the, the place where I had the procedure done.
[AGENT][NEUTRAL] But as it
[AGENT][NEUTRAL] Right, and so, uh, is it an itemized bill or is it a balance due statement?
[CUSTOMER][NEUTRAL] Uh, give me one second. I, I, I mean I can look it up to see what exactly she's, uh, the lady told me this is what you need for the, um.
[CUSTOMER][NEUTRAL] Uh, let's see, um.
[AGENT][NEUTRAL] You know, so the itemized bills should include like procedure codes, your diagnosis code, which is why you had the surgery, the doctor hospital's name, uh, their address, bill outs.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It there's a well it shows here dates of service procedure code which is a couple of numbers description, diagnosis K29.70 description as to what it was that I had done surgical um.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, physician referral, um, yes, it does, it does show on here that there are procedure codes listed.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And did you upload the, uh, primary insurance explanation of benefits that corresponds with that date of service?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I, I, I, well, it shows what they did, um.
[CUSTOMER][NEUTRAL] I haven't, I don't think I've gotten anything from the insurance company yet.
[AGENT][NEUTRAL] OK. Who was your primary insurance?
[CUSTOMER][NEUTRAL] Aetna.
[AGENT][NEUTRAL] OK, so the claim is submitted to Aetna first because they're primary and this policy with APL is secondary.
[AGENT][NEUTRAL] So in order for us to know what amount is due you we need a copy of Edna's explanation of benefits for that data service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I need to get an EOB from Aetna.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] That matches that date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, because they told me when I got to the hospital that my responsibility was 1000.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And so,
[CUSTOMER][NEUTRAL] Based on my insurance.
[AGENT][NEUTRAL] OK, and so we'll need the your Aetna's explanation of benefits to determine what amount uh to pay you if any. It's gonna depend on what's on that EOB Aetna's explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it. OK, so I'm gonna go go ahead and call Aetna and see um if I can get that from them.
[AGENT][NEUTRAL] You, you may be able to just download it from their website if you have an account. If not, I would create one.
[AGENT][NEUTRAL] Um, and download it from their website or call them whichever you prefer.
[CUSTOMER][NEUTRAL] OK, I do.
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] And then once I have that just incorporate it with my um.
[CUSTOMER][NEUTRAL] With everything that I've attached here sent to you folks, right?
[AGENT][NEUTRAL] You would, you
[AGENT][NEUTRAL] You would go to the online service center and it will be a new entry so you cannot add it to one that you've already submitted so it's like a new entry.
[CUSTOMER][NEUTRAL] Do I resubmit all the information again?
[AGENT][NEUTRAL] No, no, just the primary explanation of benefits.
[CUSTOMER][POSITIVE] Got it OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright, so I'm gonna work on that right now so that I and typically how long does it normally take for processing of these um these claims?
[AGENT][NEUTRAL] Yeah, so our standard processing time is 7 to 10 business days from the date that we received the claim. Now if we process what we already have before you send us the EOB.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then the time ticks starts ticking over again 7 to 10 business days so if you can get that as soon as you can.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And get it uploaded so that when the other claims that we previ the claims that we previously have or processed we'll have that as well, the EOB as well.
[CUSTOMER][NEUTRAL] You're done.
[CUSTOMER][POSITIVE] OK, perfect. Alright, great. Well, listen, thank you so much for your time. I'm, I'm gonna get on the Aetna, uh EOB, um, right now, literally when I hang up with you.
[AGENT][NEUTRAL] Website? OK.
[AGENT][POSITIVE] All righty.
[CUSTOMER][POSITIVE] OK great thank you so much for your time.
[AGENT][POSITIVE] You're welcome, [PII]. With no other questions, thanks for calling ATL. Have a good day.
[CUSTOMER][POSITIVE] Thank you.