AccountId: 011433970860
ContactId: 8b0b83d7-e974-40b7-a493-524e5f1ece7f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1010919 ms
Total Talk Time (AGENT): 228817 ms
Total Talk Time (CUSTOMER): 270679 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/8b0b83d7-e974-40b7-a493-524e5f1ece7f_20250228T17:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Yep, I'll call you right back. I'll.
[CUSTOMER][NEUTRAL] Hi, I'm calling for claim status.
[AGENT][NEUTRAL] May I have your name and a callback number?
[CUSTOMER][NEUTRAL] [PII] [PII] and what is your name?
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] May I please have the policy number?
[CUSTOMER][NEUTRAL] 016
[CUSTOMER][NEUTRAL] 59755.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] Messa [PII].
[AGENT][NEUTRAL] And May I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] 124 0 I'm sorry [PII] 2023125.
[AGENT][NEUTRAL] It's 7223 for 125.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And I'm pulling that information up for you now.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEGATIVE] So for that claim, it does show that we received it on [PII]. It was processed on [PII]. That claim number is 352-9217. It shows that the claim processed and it denied that the primary insurance did not cover. Then we did receive it again on [PII].
[AGENT][NEUTRAL] And it was processed on the [PII]. That claim denied as a duplicate of the previous submitted claim.
[CUSTOMER][NEUTRAL] OK, but Aetna did pay the claim.
[CUSTOMER][NEUTRAL] Aetna made a payment and I faxed and I faxed the claim and the EOB to you guys on [PII]. Aetna paid the claim.
[AGENT][NEUTRAL] Did they apply anything to the patient's responsibility?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Let me pull that up.
[CUSTOMER][NEUTRAL] $50.
[AGENT][NEUTRAL] I'm pulling the one up that was recently submitted in on 115.
[CUSTOMER][NEUTRAL] Hold on 1 2nd.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I call you right back?
[CUSTOMER][NEUTRAL] OK bye.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I'm looking at the documentation that we received in for the claim that was faxed on [PII]. It's not showing that the member's patient's responsibility is $50. It is showing that the member that this information has denied that it was requesting other.
[CUSTOMER][NEUTRAL] Over
[AGENT][NEUTRAL] Information
[AGENT][NEUTRAL] From the patient
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEGATIVE] I, I don't get where you guys get that because.
[CUSTOMER][NEUTRAL] I have, let me go to my receipt.
[CUSTOMER][NEUTRAL] I have that Aetna paid.
[CUSTOMER][NEUTRAL] $75.
[CUSTOMER][NEUTRAL] And they left it as the patient's co-pay?
[CUSTOMER][NEUTRAL] Hold on, let me see what batch I did this in.
[CUSTOMER][NEUTRAL] One second, 8396.
[CUSTOMER][NEUTRAL] Um, hold on.
[CUSTOMER][NEUTRAL] 2364's my hat now.
[CUSTOMER][NEUTRAL] I'm gonna have to do this another way. Hold on, I'm sorry.
[CUSTOMER][NEUTRAL] I just have to figure out how to do this because
[CUSTOMER][NEUTRAL] I see
[CUSTOMER][NEUTRAL] There
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] Copy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, they paid.
[AGENT][NEUTRAL] OK, so are you looking at the documentation that was submitted over to us?
[AGENT][NEUTRAL] The documentation that you as the provider submitted over via fax. It is showing listed if you will look at that second page that it does not show anything that was applied to this member's deductible, co-insurance, or co-pay. If you would look, it says adjustment code is PR 227.
[CUSTOMER][POSITIVE] Yeah, that I can
[CUSTOMER][NEUTRAL] Alright, give me one second. I have to go look through my fax stuff. Give me one minute because I could see when I faxed it. Hold on.
[CUSTOMER][NEGATIVE] And you have on the paper that I sent you have no payment at all from Aetna?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Alright, I'm gonna have to look for it because, and I don't wanna have to keep you on hold because I'm sure you have other people to take care of.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Once I find it, I'm gonna fax it back. I just wanna make sure I have the right number, the [PII].
[AGENT][NEUTRAL] Yes, that is correct. And if you would like, you can submit that and just put in those claim numbers that I gave you and then they will be able to pull the claim image up if you're only submitting the EOB. But please make sure that the EOB does indicate co-pay, deductible and co-insurance for the responsibility for the member.
[CUSTOMER][NEUTRAL] Before I had a problem with this with you guys because I don't know I wasn't reading supposedly correctly.
[CUSTOMER][NEUTRAL] And um I don't know if that's the same problem that we're having.
[CUSTOMER][NEUTRAL] What is the claim number you said?
[AGENT][NEUTRAL] There are 2 claim numbers. Those claim numbers are.
[AGENT][NEUTRAL] 352-921-7
[AGENT][NEUTRAL] And then the one that was received on [PII] is 3552816.
[AGENT][NEUTRAL] And if you were needing to pull it up, I could sit here and wait for you to be able to pull that image up.
[CUSTOMER][NEUTRAL] 2816.
[CUSTOMER][NEUTRAL] Yeah, I'm gonna ask you to because hold on.
[CUSTOMER][NEUTRAL] Because I um I just got into where my fax stuff is.
[CUSTOMER][NEUTRAL] do.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I faxed it on [PII].
[CUSTOMER][NEUTRAL] Trying maybe it failed. I don't know because.
[CUSTOMER][NEUTRAL] Sent
[AGENT][NEUTRAL] We have the facts cause it's showing that it came in at [PII].
[AGENT][NEUTRAL] That you send me, send it in on [PII] at [PII].
[CUSTOMER][NEGATIVE] See and I can't find it where I sent it.
[CUSTOMER][NEUTRAL] It's like I don't have it and that's the strangest thing because you even said you have it.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] We have the cover page then we have the claim, and then we have the remittance advice and the remittance advice does not have that information.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK, let me um let me pull this and then um.
[CUSTOMER][NEUTRAL] Hold on, give me one second, hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, give me one second because I have to go through avail because for some reason this one.
[CUSTOMER][NEGATIVE] Um, was not.
[CUSTOMER][NEUTRAL] Um, loaded into our system, we were having issues with, uh, stuff getting loaded into our system for Aetna.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] So I thank you for being patient with me.
[AGENT][POSITIVE] Oh, no problem.
[CUSTOMER][NEUTRAL] 10332325155 patient.
[CUSTOMER][NEUTRAL] Member ID is W270526088 patient.
[CUSTOMER][NEUTRAL] Let me ask
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 72.
[CUSTOMER][NEUTRAL] 72 2023.
[CUSTOMER][NEUTRAL] Alright, let me look at this EOB hold on.
[CUSTOMER][NEUTRAL] OK, what I'm looking at.
[CUSTOMER][NEUTRAL] It states that um.
[CUSTOMER][NEUTRAL] We billed $125 they allowed $125. The co-payment amount is $50.
[CUSTOMER][NEUTRAL] And they paid $75 and then it says patient responsibility $50.
[AGENT][NEUTRAL] OK. But is that the image that you faxed over, cause that's not what we received via fax.
[AGENT][NEGATIVE] The image that we received on [PII], it is showing billed amount allowed amount. There's nothing listed in the deductible coinsurance is given a PR 227.
[CUSTOMER][NEUTRAL] OK, I, I, I don't know because for some reason I cannot pull up.
[CUSTOMER][NEUTRAL] OK, the one that, yeah, this one I don't know what it looks like the one I sent over to you, um, but can I send you over this one?
[AGENT][NEUTRAL] Yes, as long as it shows the deductible coinsurance or co-pay, that examiner will receive it.
[CUSTOMER][NEUTRAL] Yeah, because it says 125 and then it says co-pay amount 50, patient responsibility 50, payable amount 75.
[AGENT][NEUTRAL] Yeah, all I can tell you is you can submit it over and that examiner will pull it and if it's eligible to be processed and paid, that examiner will process it as received.
[CUSTOMER][NEUTRAL] OK, and do I use um the claim I can you said I can fax it with just the claim number I don't, I mean yeah the claim number and the EOB I don't need to send another claim?
[AGENT][NEUTRAL] No, because we, they will be able to pull that claim image up that we received in the system.
[CUSTOMER][NEUTRAL] OK, so I should use the 3552816 then correct?
[AGENT][NEUTRAL] You would use, let's see, that would be the new, well, you can use either one because both of them have the same image attached.
[CUSTOMER][POSITIVE] OK, perfect, thank you so much. I'm sorry I had you on the phone for a long time. Can I get a reference number please?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes, the reference number would be my first name, [PII], last initial of [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you [PII] have a blessed Friday.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day, [PII].
[CUSTOMER][NEUTRAL] Uh bye bye.