AccountId: 011433970860
ContactId: 85b802e8-af67-4e02-875b-ec37a4c0dc55
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 565080 ms
Total Talk Time (AGENT): 218308 ms
Total Talk Time (CUSTOMER): 103422 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/85b802e8-af67-4e02-875b-ec37a4c0dc55_20250514T15:19_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh yeah, hi, this is [PII], that is uh [PII] calling from provider's office regarding claim status.
[AGENT][NEUTRAL] OK, OK, thank you. And what is the, the policy number that we're looking at today?
[CUSTOMER][NEUTRAL] Uh, that is 02035770.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] That is [PII], [PII].
[AGENT][NEUTRAL] OK, and let me make sure that I have the, I'm sorry, I'm having a little trouble with my phone. You said the, the, uh, policy number is 02.
[AGENT][NEUTRAL] 035770.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh yes, right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] Doesn't seem to be going to the person that uh that you have listed so let's see if we can't find it by their name um.
[AGENT][NEUTRAL] How, how do you spell the patient's last name, please?
[CUSTOMER][NEUTRAL] That is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the first name, please?
[CUSTOMER][NEUTRAL] That is [PII]
[AGENT][POSITIVE] I do appreciate that and I'm sorry, what was her date of birth again?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] Thank you. Well, I'm looking that up, I'd like to just have a callback number please in the event that we're disconnected.
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] Oh yeah, that is [PII].
[AGENT][NEUTRAL] OK, thank you. I'm just trying to find her policy now.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK. Excuse me, just one moment, please.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, it looks like the policy number is 02.
[AGENT][NEUTRAL] 03
[AGENT][NEUTRAL] 5270. And what date of service were you looking for for [PII]?
[CUSTOMER][NEUTRAL] Uh, that is [PII].
[AGENT][NEUTRAL] And is there a particular building amount that I should look for?
[CUSTOMER][NEUTRAL] Uh, $286 even.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like the claim number for this.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] 356.
[AGENT][NEUTRAL] 2313. So that's 3562313.
[AGENT][NEUTRAL] It looks like we received that claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We received that claim on the [PII].
[AGENT][NEUTRAL] We processed it on the [PII].
[AGENT][NEUTRAL] Now, we are the secondary, yes, we are the secondary insurance for [PII]. So in order to process the claim, we need the explanation to benefit from her primary insurance.
[CUSTOMER][NEUTRAL] 1
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, actually, we did send it on [PII].
[AGENT][NEUTRAL] OK, let me pull up this.
[CUSTOMER][NEUTRAL] So, can you check if you received that?
[AGENT][NEUTRAL] Yeah, let me just pull up the paperwork that you've got here.
[AGENT][NEUTRAL] I'm just waiting for this
[CUSTOMER][NEUTRAL] Me
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what I'm doing right now is I'm looking at the paperwork that we received for that claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the estimation of benefits that we received um.
[AGENT][NEUTRAL] It was a portion of it.
[AGENT][NEUTRAL] Um, so it looks like the bottom half of the explanation of benefits.
[AGENT][NEUTRAL] was what was sent. So we have 3 pieces of paper here. We have the um uh fax cover sheet.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Uh, and then it says, uh, you know, has that information. The second page, um, it, it just says claim is denied for for primary EOB, hence attaching the EOB below, and the EOB that we received is just the bottom half of the EOB but there's nothing else on it and it's illegible. And so what they've done is they've asked for another explanation of benefits because.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There there's nothing here that we, you know, it's, we see a bunch of numbers but it's, um, it's only the bottom half of the EOV. It's, it's not the entire form. So if you wouldn't mind sending that back to us, uh, so that we have the entire explanation of benefits that way we can see that it's for the right charges for the right day, um, but that is why that was denied is because those those documents, uh, we only received a portion of them rather than all the documents that we needed.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. So you do require it again with proper UP?
[AGENT][POSITIVE] Yes, please, yeah, with, with the entire E it's where it's not to cut off.
[CUSTOMER][NEUTRAL] OK. May I get the fax number?
[AGENT][NEUTRAL] It's 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 9423.
[CUSTOMER][NEUTRAL] 9423. All right. And the reference number?
[AGENT][NEUTRAL] We, you would just send it to the claims department.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, is, is there any other plan that we needed to look at?
[CUSTOMER][NEUTRAL] Mm, no, just a single claim.
[AGENT][NEUTRAL] OK, OK, well, we'll be on the lookout for that, and if you don't mind sending that to us and that way we can have the entire explanitu benefits and we can finish processing the claim.
[CUSTOMER][NEUTRAL] OK, sir. I'm sorry, can you again, uh, repeat the claim number, please?
[AGENT][NEUTRAL] Yes, the claim number is, yeah, 35.
[CUSTOMER][NEUTRAL] That is
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 62313.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, OK. Uh, and the color reference number, finally.
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII], and we'll use this in today's date of our.
[CUSTOMER][NEUTRAL] Uh, I'm sorry, can you spell your name, please?
[AGENT][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Why?
[CUSTOMER][NEUTRAL] Oh, [PII].
[CUSTOMER][POSITIVE] OK, then. Thank you so much, [PII]. Have a great day.
[AGENT][POSITIVE] OK, thanks for contacting us have a good day.