AccountId: 011433970860
ContactId: 67f01f3e-1d26-4a19-9c19-2d7ac9bc348b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 759030 ms
Total Talk Time (AGENT): 246810 ms
Total Talk Time (CUSTOMER): 477905 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/67f01f3e-1d26-4a19-9c19-2d7ac9bc348b_20250514T15:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. This is [PII] calling. I'm calling because I think there was a misunderstanding with some dates on a payment that needs to be made to the urgent care, and I wanted to see if we can go through that so that payment to them can be sent.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you with claim status. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK. And could I get your policy number, please?
[CUSTOMER][NEUTRAL] Uh, I got an outpatient inpatient group number. What do you need, honey?
[AGENT][NEUTRAL] The outpatient number.
[CUSTOMER][NEUTRAL] OK, the outpatient number is 01369.
[CUSTOMER][NEUTRAL] 754.
[CUSTOMER][NEUTRAL] ML and the number 8.
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. My home address is [PII].
[AGENT][NEUTRAL] OK, thank you. And please verify your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And what's the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] Well, the thing is I'm explaining and then you kind of figure out. I went to urgent care on [PII] and then I end up going back to the same urgent care on [PII].
[CUSTOMER][NEUTRAL] So on [PII], that urgent care was supposed to bill you, um, you know, for the $125 copay, which they did on [PII] according to them.
[CUSTOMER][POSITIVE] And then when I went back on [PII], they wouldn't take you guys for some odd reason, so I ended up paying my co-pay out of pocket $125 and uh I had called you guys and and the lady says just pay it and then put the claim in and I did that. So you did reimburse me for 210 payments that I made to the urgent care. That's no problem.
[CUSTOMER][NEGATIVE] The date of service that's the issue is [PII] because they billed you electronically on [PII] for service for [PII] and they haven't received the payment yet.
[AGENT][NEUTRAL] OK. Yes, ma'am.
[CUSTOMER][NEUTRAL] And I don't know why.
[AGENT][NEUTRAL] Yeah, I'm showing the claim that we received on [PII] um from the provider according to the EOB that they sent us along with the claim from your primary insurance company. It appears that your primary insurance company did not cover the copay. And if the primary insurance um denies a charge as your secondary, we deny it also. But if you have an updated explanation of benefit showing where the primary carrier covered it.
[CUSTOMER][NEUTRAL] Oh yes.
[CUSTOMER][NEUTRAL] Hold on
[CUSTOMER][NEGATIVE] I'm sorry, sorry, I was sneezing at the same time. My apologies. Thank you, but that's what doesn't make sense. My primary never pays my copay co-pay for urgent care. You guys cover it.
[AGENT][POSITIVE] Oh bless you.
[CUSTOMER][POSITIVE] My primary pay is Cigna pays a a a portion and then my co-pay for the urgent care you guys cover for years. So it wasn't denied.
[AGENT][NEUTRAL] Right. Yes, ma'am. And that's
[AGENT][NEUTRAL] Yeah, that's how, and that's how it works. But according to the EOB that we received um for the [PII] date of service, it appears that the primary insurance did not cover any of those charges. And if the primary insurance doesn't cover any, then we don't cover either. But as I was saying that um right, but if the EOB if you have an updated EOB showing that they did cover their portion and a portion went to the co-pay, you can submit that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, that makes sense.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEGATIVE] I have to submit it, but, but I didn't pay, but I didn't. Well, according to them they got paid for 26 from Signa. Oh, they're just waiting for you guys to pay your portion. That's from what I understood by them, but I could be totally wrong. They were gonna they were gonna mail me all this information, but I can double check if you give me a second. Let me, um.
[CUSTOMER][NEGATIVE] Hold on a second. Uh, my allergies are really kicking my ass today. I could tell you that.
[AGENT][NEUTRAL] I understand. Trust me.
[CUSTOMER][NEGATIVE] Really bad, OK.
[CUSTOMER][NEGATIVE] Oh my gosh, and now that you're talking to me and I feel bad because I'm like sneezing, like I can't understand. I'm sneezing. Hold on a second.
[AGENT][POSITIVE] Yes, no problem.
[CUSTOMER][NEUTRAL] Give me a second. If I could find this, if I could find the darn card it'll be good. Hold on sweetie, uh.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] This is my husband's card for his stuff. I know I have it. You know, when you have it, you just got too much shit. I got too much shit. That's the problem.
[AGENT][NEUTRAL] Yeah, it sounds like they may have an updated explanation of benefits and if they do, they can also resubmit the claim.
[CUSTOMER][NEUTRAL] Hold on a minute.
[AGENT][NEUTRAL] To be paid.
[CUSTOMER][NEGATIVE] I think they, uh, I don't know what they did because, you know, you know how it is, and, and they gave me such a, yeah, an issue. And I was like, are you kidding me? But, you know, it is what it is. So I do have a, I'm gonna put you.
[CUSTOMER][NEUTRAL] I do have a user ID and password for signal so I can log in and then I can tell you and you can tell me what I need to do if you don't mind.
[AGENT][POSITIVE] Sure, no problem.
[CUSTOMER][NEGATIVE] OK, give me a second because I wanna resolve the issue versus them showing I owe something and you show you pay, you know, it's a nightmare.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So hold on, let me see if this works.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Let's see if I didn't have one.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, then give me a text message on my phone. Hold on.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Verification 101.
[CUSTOMER][NEGATIVE] They never, they just said my balance for 26 was um was 125 and I'm like, and they said and that's because you guys haven't paid and I'm like, OK, so let me figure out why because the data service did happen to know. OK, I'm gonna go to, should I I should go to claims.
[AGENT][NEUTRAL] Right, yes, ma'am. Go to planes and
[CUSTOMER][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] You should be able to filter it by the date of service.
[CUSTOMER][NEUTRAL] I, I'm gonna say I I.
[CUSTOMER][NEUTRAL] OK, you claims within the year to date, you know what, [PII].
[CUSTOMER][NEUTRAL] Yeah, it says MD now on 26 claim processed on [PII] and it says my and it says bill 341 patient responsibility $125 hold on.
[CUSTOMER][NEUTRAL] Uh, so cost reduction what my plan paid was $82. Cigna paid $82 on 26.
[AGENT][NEUTRAL] OK, so we'll need that updated explanation of benefits and once we receive that, we can get the claim reprocessed.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] OK, so what I'm gonna do is I'm going to print.
[CUSTOMER][NEUTRAL] I'm gonna print this, hold on.
[CUSTOMER][NEGATIVE] And then you tell me if you want me to email it to you. I don't know what you want me to do because I'm not requesting this money for me, you know what I mean? It's for them because they're billing you guys for it, so what do I do?
[AGENT][NEUTRAL] Well, if you submit the claim, we'll pay you. So what you would need to do is contact them and um let them know that they have that updated explanation of benefits and to refile the claim for 26 with us.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So they can be paid and we'll pay them.
[CUSTOMER][POSITIVE] OK, I'm sorry. You.
[CUSTOMER][NEUTRAL] So you want me, you want me to tell them to resend the explanation of benefits from Cigna when I'm just printing out now, is that what you want me to?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right. Yes, ma'am, for 26.
[CUSTOMER][NEUTRAL] My call, OK.
[CUSTOMER][NEUTRAL] OK. Well, I can't just send it to you and then you pay them? Like, I can't do that?
[AGENT][NEUTRAL] Um, no, ma'am. You can't file the claim for them because if you were to file the claim, then the payment will go to you.
[CUSTOMER][NEUTRAL] Well, if the payment goes to me, then I just pay them. Who cares? Does it make a difference?
[CUSTOMER][NEUTRAL] Or no?
[AGENT][NEUTRAL] That sounds, um, yeah, as long as you know that if you submit the claim, the payment will go to you and then you can pay them. That's fine because it's your money, so.
[CUSTOMER][NEGATIVE] Yeah, I can do that. I can because it just sounds like these people don't got their crap together, so I figured if I gotta do this crap, I'll do it. So you tell me what I need to do to file this thing because I was just give them the money, I guess, because I, when I talked to them, they said they sent it on [PII], and they've been waiting and waiting and waiting and waiting and waiting and I'm like they need the confusions between the 210 and 26 service. I'm like, I don't know. So what do I need to do sweetheart? You tell me because I didn't pay it out cash. I could tell you that.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Well, did you have?
[AGENT][NEUTRAL] Did you file the claim for the payment that we sent you on [PII]? It looks like you filed the claim then, so you, you would submit the.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, I did.
[AGENT][NEUTRAL] Yeah, you would do the same thing.
[AGENT][NEUTRAL] It it sounds like you probably went online.
[CUSTOMER][NEUTRAL] I don't remember what the heck I did then.
[AGENT][NEUTRAL] You can file the claim online or you can fax us the explanation of benefits, whichever one is easier. You can fax it, you can mail it, or you can submit the claim online. Which way do you prefer?
[CUSTOMER][NEUTRAL] I don't remember what I did that.
[CUSTOMER][NEGATIVE] So I have the explanation of benefits from my signa right now, so I just printed it out and so I gotta get that paper I guess to claim even though I don't have a receipt that I paid because I did not pay it for that day. I didn't and money didn't come out my pocket, so as soon as I send this, then it shouldn't be much of an issue and and I don't need a receipt because I didn't pay it, right? Obviously I didn't pay this.
[AGENT][NEUTRAL] Right, because what we, what we basically.
[CUSTOMER][NEUTRAL] So, you know what I mean? Don't I need a receipt?
[AGENT][NEUTRAL] Well, no, cause we go by the um the uh ELB from the primary insurance company. If it shows that you're, you're owed that amount, it went towards your co-pay, your co-insurance or deductible, that's what we go by.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, that's all we'll need.
[CUSTOMER][NEUTRAL] OK, so I should just get that paper, get that paper, do the explanation of benefits, which is this. What else do I need to submit? I know I needed to submit a bunch of things. I couldn't remember the last time when I did it. I mean, I know I have to log in. I maybe I'll just print that paper. Can you give me your fax number if you don't mind?
[AGENT][NEUTRAL] Um, yes, our fax number, mhm. Our fax number is [PII].
[CUSTOMER][NEUTRAL] That I'll need to fax it to?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII] and please attention it to the claims department.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Pension claims department.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'll just, I'll just go ahead and give it to them.
[AGENT][NEUTRAL] And let me give you this information. Let me um give you the claim number for the 26 date of service and um reference this claim number, let us know that um this is the EOB for this claim. Um, the claim number is 3570175.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 3570175. OK, and just put that the reference so that's the EOB and the reference number and it's the claims department.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] For this kind.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] So it's quite OK.
[CUSTOMER][NEGATIVE] Alright, because it seems like they don't got their ducks in the world, so if I don't do it, it's not gonna get done.
[CUSTOMER][NEUTRAL] See you know what I mean, I'll just, I mean, I just feel like if I call them back it was forever to get someone. If I call them back and they resubmit it, they're not gonna resubmit it with the explanation of benefits. It's just gonna be a circle, so I'd rather just, I'll do it myself. I'll send it to them. Alright mama, so I'll process this myself.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm right.
[AGENT][NEUTRAL] Yeah. Yeah, and you'll receive the payment and then you can go pay them.
[CUSTOMER][NEUTRAL] That's fine. [PII] is the fax number. Alright, so I just need the EOB and the paper and I don't need anything else. Those are just the two things I need and that's it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Yes ma'am, that's correct.
[CUSTOMER][POSITIVE] OK, just double check and Chika, thank you very much. I appreciate your help.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] No, I think I'm good. I'm pretty sure I'm good. Thank you. I appreciate it. All right, have a good day, honey.
[AGENT][NEUTRAL] OK. You're welcome, [PII]. You do the same.
[CUSTOMER][POSITIVE] OK, OK thanks bye.
[AGENT][NEUTRAL] Bye.