AccountId: 011433970860
ContactId: 63c5230f-85ed-4da7-9e38-d924a10ffe1b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1265660 ms
Total Talk Time (AGENT): 283403 ms
Total Talk Time (CUSTOMER): 263649 ms
Interruptions: 7
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/63c5230f-85ed-4da7-9e38-d924a10ffe1b_20250115T15:26_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, what's your name?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] Yeah, hi, sir. My name is [PII] calling from provider's office and very good morning to you.
[AGENT][NEUTRAL] tell me.
[CUSTOMER][NEUTRAL] Uh, so I'm calling to check upon the claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status, Mr. [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is 02352924.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, member name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] Perfect. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It is [PII]. Bill amount is $1,464 even.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for you and that's February 21 of 24 $1,464.
[AGENT][NEUTRAL] Yeah let's see.
[AGENT][NEUTRAL] And for future you can check claim status online through our website at [PII] and that's just optional. In one moment, let me pull this ELB.
[CUSTOMER][NEUTRAL] In front
[CUSTOMER][POSITIVE] secure.
[CUSTOMER][NEUTRAL] It's just
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] One moment, I'm still waiting on the EOB.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, here it is. It looks like we processed the claim on [PII] and the claim was denied, and it looks like um the policy does not provide benefits other than sickness or injury.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] for injury.
[CUSTOMER][NEUTRAL] Mm, so you mean to say this is non-covered services?
[AGENT][NEUTRAL] Correct, it's a non-covered service.
[CUSTOMER][NEUTRAL] Alright, and what plan this member has?
[AGENT][NEUTRAL] You need the claim number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, the claim number is 34543557.
[AGENT][NEUTRAL] And this is a secondary supplemental plan to the major medical.
[AGENT][NEUTRAL] For medical, um, for sickness or injury only.
[CUSTOMER][NEUTRAL] OK, and what plan does member has?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical for sickness or injury only. It doesn't cover preventative.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] So you're could you let me know what is the appeal filing limit?
[AGENT][NEUTRAL] 180 days from the decision date?
[CUSTOMER][NEGATIVE] This is already been crossed.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Do you have a fax number to send an appeal?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, the fax number is [PII]. Attention claims or appeals department.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Let
[CUSTOMER][NEUTRAL] Right, right, so we do not have any information about this, then now, so can you fax me the UB please.
[AGENT][NEUTRAL] OK, what is the fax number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] To what attention?
[CUSTOMER][NEUTRAL] My name [PII].
[AGENT][NEUTRAL] OK. Do you mind holding for me while I send this out to you while I've got you on the line?
[CUSTOMER][POSITIVE] Yes, of course.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me Mr. [PII]. Yeah, I went ahead and sent that over to you. It should be there in a few minutes. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Over to you should be
[CUSTOMER][NEUTRAL] Uh, yes, so I have a few more claims with me, so can you let me know how many claims can you help me on this call?
[AGENT][NEUTRAL] How many do you have?
[CUSTOMER][NEUTRAL] Mm, just for a moment 12 I have 2 more claims with me.
[AGENT][NEUTRAL] 2 is fine. Um, what is the next policy number?
[CUSTOMER][NEUTRAL] OK, just give me a moment here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, so the policy number is 02288208.
[CUSTOMER][NEUTRAL] M M as in Mike. L as in Lima 8.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Member name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It is [PII] for the bill amount $3,575 even.
[AGENT][NEUTRAL] OK, let me see if I can find this one and that was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] fine.
[AGENT][NEUTRAL] Let me pull the ERB.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This is for canal endoscopy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, so we process the claim [PII] and let's see.
[AGENT][NEUTRAL] It looks like um this is a duplicate. The claim has been processed under insured.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Mm, can you explain me that?
[AGENT][NEUTRAL] The patient has sent in the claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Before we got the provider's claim.
[CUSTOMER][NEUTRAL] You can see that the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what is the original details on the claim?
[AGENT][NEUTRAL] When you say the original details of the claim, what do you mean?
[CUSTOMER][NEUTRAL] something.
[CUSTOMER][NEUTRAL] Right, as you received the uh.
[CUSTOMER][NEUTRAL] The claim by uh from the patient. So what is the details for that claim? Is it processed? Is it paid or is it?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We cannot release that information.
[AGENT][NEUTRAL] Mm, we cannot release any details on that claim because it was um processed with the patient, um, and that information cannot be disclosed. The only thing I can give you is the denial reason of your claim, which is indicating that the, it appears to be a duplicate of previous submitted expense and benefits has been paid to the insured. That's all the information I can give you.
[CUSTOMER][NEUTRAL] details so that was.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I can give you this piece of time which is indicated.
[CUSTOMER][NEUTRAL] has been paid to the.
[CUSTOMER][NEUTRAL] Alright, so can you fax me that you will be? Will that be possible?
[AGENT][NEUTRAL] I can fax you the copy of your EOB, yes. What is the fax number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The same that is [PII].
[AGENT][NEUTRAL] OK, one moment, let me put you on a brief hold while I send it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK thank you for holding and being patient for me you can go ahead and send that one over to you. It should be there in a few minutes.
[AGENT][POSITIVE] And I'm ready for the next one. Yeah, go ahead.
[CUSTOMER][NEUTRAL] Got it. So you, alright, so you can you help me with the uh claim number for the for the duplicate claim?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure. And uh well, the claim number for your claim, because that's the only thing I can release. The claim number is 3541767.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date.
[CUSTOMER][NEUTRAL] Got it. Alright, so here we go on to the next number.
[AGENT][POSITIVE] Mhm, I'm ready for the numbers.
[CUSTOMER][NEUTRAL] Alright, so the policy number is 01883790 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, member name is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, last the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] for the bill amount $1850 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's [PII].
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] OK, so it looks like we processed the claim on [PII] and we're needing the explanation of benefits from the primary insurance to continue the processing of this claim.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, so upon checking here I do see that the primary insurer is American Public Life.
[AGENT][NEUTRAL] We're not the primary. Let me see who's the primary. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Primary Cigna.
[CUSTOMER][NEUTRAL] Can you help me with the member ID number for Cigna?
[AGENT][NEUTRAL] We don't have that information. We can only see the name.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And when was the last you be updated?
[AGENT][NEUTRAL] I'm not sure when is it updated with Cigna because Cigna is a major medical. We don't update that information.
[CUSTOMER][NEUTRAL] update
[CUSTOMER][NEUTRAL] Can you help me with the claim number?
[AGENT][NEUTRAL] OK, yes, the claim number is 3547451.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] All right, so
[CUSTOMER][NEUTRAL] As I checked in my system, so I was able to pull out the other member, uh, the other pair that is has Aetna. So could you check and confirm, is it Aetna or Cigna because I have the Aetna Medicare number as well.
[CUSTOMER][NEUTRAL] Member ID number as well.
[AGENT][NEUTRAL] based on my system is Cigna. We don't have any other information.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright, so that's all for today and thank you so much for your help. I really appreciate that.
[AGENT][POSITIVE] You're welcome and thank you for calling ATO. Have a good day, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.