AccountId: 011433970860
ContactId: 90a1b1f9-b06d-469c-9733-2fec62d6ff0f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 816640 ms
Total Talk Time (AGENT): 567086 ms
Total Talk Time (CUSTOMER): 225369 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/90a1b1f9-b06d-469c-9733-2fec62d6ff0f_20250117T16:45_UTC.wav
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[AGENT][NEUTRAL] This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Hi [PII]. Happy Friday, happy 3 day weekend, woo hoo.
[AGENT][POSITIVE] Oh yeah, I know, finally, yeah nice.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I've got an, uh, well, it's a dependent on the line, but he's calling about his wife's claim, um, policy number 223.
[CUSTOMER][NEUTRAL] 0090.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, Mr. [PII] is checking they received the EOB for claim number 354.
[CUSTOMER][NEUTRAL] 8152.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And he's calling to see what.
[CUSTOMER][NEUTRAL] This is for, for a Nicholas Children's Hospital for his wife.
[AGENT][NEUTRAL] Oh, yes, of course. Um, yeah, I'm sorry. I'm just waiting for it to come out my uh.
[CUSTOMER][NEGATIVE] I know it's going so slow.
[AGENT][NEUTRAL] I know it is. It's really a pain. OK, so let's see, this is just sent.
[AGENT][NEUTRAL] OK, and he wants to know because it says Children's Hospital, he's wondering what the heck, right?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, yeah, no, I get it. I get it. Yeah, that, uh, so yeah, I'm just pulling it up here.
[CUSTOMER][POSITIVE] Yep, yep, yep, yep. Yeah, I would too.
[CUSTOMER][NEGATIVE] I finally got it to come up and it looks like it's the wrong provider and I don't even understand the benefit amount.
[AGENT][NEUTRAL] No, I completely understand.
[AGENT][NEUTRAL] $600 OK.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] How do we pay $600? oh gosh.
[AGENT][NEUTRAL] It's a good question. Um, let's see.
[CUSTOMER][NEGATIVE] I think this is all totally wrong.
[AGENT][POSITIVE] OK, so we got the person, right? That's always good.
[AGENT][NEUTRAL] Whoa.
[AGENT][NEUTRAL] Oh, Lord love a duck. OK, so yeah, it is, it's way off. It's, uh, OK, all right, yeah, OK, so let's see, so that's all, that's her. This is this, this is that, so this is all office.
[AGENT][NEUTRAL] Now I'm thinking she doesn't, this, these don't have office, well, I'll just check. I, I'm pretty certain that this, this wouldn't, none of this would be covered but 230,090.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] All right, so we know about that. OK, so what, um, um, so what I can do is I can explain to them that uh this was, um, none of this is covered because they don't have the office visit for one thing, and the rest of this stuff isn't, you know, there's no charge. And so what I can tell them is that um this is uh the wrong provider was placed on this and what probably ended up happening is that you can open up more than one.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, screen at the same time. And I think they probably just pulled the wrong mail number. But that's OK. I'm not gonna tell them that. Uh, I can just tell them that, uh, that, um, this was supposed to be an office visit and sent to the wrong provider, uh, that somehow this got crossed in the mail and, and then we will, we will get it fixed and we will um send it back to, uh, let me see if I can find the doctor's office here.
[AGENT][NEGATIVE] Oh, this thing is annoying.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Then we will we can contact the uh Memorial uh internal medicine, um, MH internal medicine doctor um [PII].
[AGENT][POSITIVE] That yakonda and let them know that this is, you know, we can get this fixed. So this can be, it's fixable. I don't know what the, what the ER thing is, uh, whoever this is, I'll have to figure that one out. But this one, I can, uh, I can send it back to the to the uh examiner, but I'll be glad to let them know, um.
[AGENT][NEUTRAL] What is, uh, what's going on with this and uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so if you just want to send it, am I talking to [PII]? It's [PII] that I'm talking to? OK.
[CUSTOMER][POSITIVE] It is, it is, and I verified all their information and, and then they'll also get that $600 credited back to his, their policy, right?
[AGENT][POSITIVE] Awesome.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] That's what, yes, that's the first thing that's going to happen is that um when I send this back to [PII], I'm gonna ask that the $600 be credited back to their, um, uh, to their benefits. So that, that won't be a problem at all. Um, the, and I'll go ahead and let them know that, and, and that will happen today. I'll, I'll have every, I can um send all this back and I can.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] Is it [PII] or [PII]?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh, well, uh, um, on the history thing, it says.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Looks like the examiner may be [PII].
[AGENT][NEUTRAL] We
[AGENT][NEUTRAL] Well, uh
[AGENT][NEUTRAL] Really, because, well, hang on a second, because here, let me, let me go to history.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] C X A.
[AGENT][NEUTRAL] Well, but it's, it's OK, so I'm seeing today, I'm seeing you.
[CUSTOMER][NEUTRAL] A E W.
[AGENT][NEUTRAL] We, we, we were
[CUSTOMER][NEUTRAL] That's gonna be the examiner, the user name.
[AGENT][NEUTRAL] But it says [PII]. It's.
[CUSTOMER][NEUTRAL] That's weird. But you see on the EOBI it says.
[AGENT][NEUTRAL] I'm looking at the right one, right?
[CUSTOMER][NEUTRAL] He should choose C Z K X A 8 D W.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Hang on just a second, let's see.
[AGENT][NEUTRAL] OK, let me, let me get this other thing.
[AGENT][NEGATIVE] Oh, come on, come on.
[AGENT][NEUTRAL] Where are you seeing that?
[CUSTOMER][NEUTRAL] And ELBI under the user code.
[AGENT][NEUTRAL] Oh, yes, I'm sorry. Um, OK, then, well, I don't know what, what it is because, OK, so when I'm, I'm, I pulled up the actual thing. Let me try. OK, let me, hold on just a second. I'm gonna try it again. Hang on just a second.
[AGENT][NEUTRAL] OK, so the rolling sequence number.
[AGENT][NEUTRAL] Is 10,625,350. Does that sound right?
[CUSTOMER][NEUTRAL] I don't even, yeah, but I don't even see [PII] in the, in the history.
[AGENT][NEUTRAL] Neither do I, so I don't know, uh.
[CUSTOMER][NEUTRAL] That's weird.
[AGENT][NEUTRAL] OK, so I pulled it back up. I'm going to history and it's, I'm still showing uh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Well then, what's uh
[AGENT][NEUTRAL] I'll ask [PII] about this, um.
[CUSTOMER][NEUTRAL] Bec[PII] it looks like [PII] is the one that processed it.
[CUSTOMER][NEUTRAL] That's weird.
[AGENT][NEUTRAL] [PII] [PII], is that?
[CUSTOMER][NEUTRAL] Yeah, yeah, I put in the Z the ZKXA8DW and it pulls up [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. What did you put that into? What is the, the system that cause I, I've, it's been so long.
[CUSTOMER][NEUTRAL] In Teams if you go up to the search bar and put the user code you'll get the name of the person.
[AGENT][NEUTRAL] Oh, it seems
[AGENT][NEGATIVE] OK. There was, there used to be a system that we could do that. There was a thing and I never do, I never, I never ever bothered to do that anymore, um.
[AGENT][NEUTRAL] No, yeah, I see where it goes. OK.
[AGENT][NEUTRAL] Well, uh, I wonder if I shouldn't just send it back to both of them.
[AGENT][NEUTRAL] You know, it's, well, I'll send it back to [PII]. It's fine. I'll send it back to [PII]. That's who it goes to. OK, so, OK, so we're good on that. So I'm sending it back to [PII]. And so, um, so what I'm gonna do is I'm gonna send it back to [PII]. I'm gonna ask for this to be um reprocessed, OK? And then, uh, what, um, what happen is, is, is that uh that $600 will be uh refunded back to their account. But if you'll let me talk to [PII], then what I will do, uh, [PII] is I, I will just uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] I'll let them know what the problem is without, you know, it's making it sound too awful and uh.
[CUSTOMER][NEUTRAL] Got you
[AGENT][NEUTRAL] I'm trying to think of something to say here. I'm sorry.
[CUSTOMER][POSITIVE] Right, I know. Well, I appreciate your help. It has been. We get a three-day week in [PII].
[AGENT][NEUTRAL] It's been a long week.
[AGENT][POSITIVE] Well, have a good time during that. It's nice, isn't it?
[CUSTOMER][POSITIVE] Yes, you have a wonderful day. One moment. Let me get Mr. [PII] on the line.
[AGENT][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Mr. [PII], thank you for your patience. I do have [PII] on the line. She has been reviewing that claim information for you, and I'll assist you further. You have a wonderful day.
[CUSTOMER][POSITIVE] Thank you you too thank you bye bye.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Yes. Hi, my name is [PII]. I'm in the claims department. I went ahead and pulled up the, the record and, uh, what, um, what this was was that it was sent to the wrong provider. Uh, it's, uh, they have a, um, they have a provider uh federal ID number and it was, it was like two digits off and that sent it to, uh, Nicholas Children's Hospital rather than, uh, I think his name is uh [PII], the doctor at a memorial.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] So what we're going to do now is um we're going to go ahead and um send, we're, we're having the claim reprocessed. The money that was applied to the um to the ER visit, which is not your, your wife's, is going back into her um her balance, her outpatient balance. So, so she hasn't lost $600 of her, of her benefits. We're putting it right back today.
[CUSTOMER][NEUTRAL] Uh-huh, yeah.
[AGENT][NEUTRAL] And then we're contacting Doctor [PII] and letting him know that, that this will be reprocessed um and sent to him at uh Memorial Medical Associates. Now, is this the only, uh, and this will all be done today. Now, is there, is this the only claim that we need to look at [PII] or do we have any others that you had?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] I have no idea. This is, I just got this in the mail today and I was like I have no idea who this children's hospital is, so.
[AGENT][NEUTRAL] Right, yes, that's what it, what it is is it's there, there are two claims that went out in that in that uh federal tax ID number when they, when it was encoded, uh, it was two digits off and that's why it's, um, why you were sent that and so but but we want to make sure with the provider that that they that they understand that that is the problem.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so we will be calling um Doctor [PII] and letting him know uh that this will all be reprocessed and, and uh that money put and it wasn't actually taken out of the, the benefits, but we'll make sure that it wasn't and, um, but yes, that, that's what happened. That's why it it showed [PII] Children's Hospital rather than Doctor [PII], excuse me, uh, [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So is there an actual bill for Doctor [PII] that I'm
[CUSTOMER][NEUTRAL] That that's for $600 or that was just for this wrong one that was billed?
[AGENT][NEUTRAL] That was the wrong one. That was the wrong one and that one is, is going to be fixed. Now, there is an office visit for your wife for [PII]. Um, there was an office visit and it looks like there were several um examinations and no charge examinations, uh, and that's what we will be processing today.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Everything should be taken care of that is what you're telling me.
[AGENT][POSITIVE] Yes, we're, yes, what we're gonna do, yes, uh it's, um, yes, what we're gonna do is all we have to do is go in and re-encode it. Um, we also let the provider know what is, what is happening, um, and, uh, that way that they, you know, you're not getting billed for this and and I'm like, I'm very glad it sounds like you have not been billed for this yet, so that's great, uh, and but it will be.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I haven't seen a
[CUSTOMER][NEGATIVE] Just got your statement and it said total build charges 42 61 72 and total you guys paid with 600 so I wanna make sure that I'm not getting uh another bill here for whatever this 4200 OK.
[AGENT][NEUTRAL] No, sir.
[AGENT][NEGATIVE] No, no, no, no, no, no, no. That is a, that is a different patient altogether and it's, and the only reason that you got that is just because of that two-digit um uh mistake when, when encoding. And so, no, sir, you do not owe this. This is not for your wife, um.
[CUSTOMER][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So the
[CUSTOMER][NEUTRAL] OK, I, I just got cleared up. I didn't know if you guys caught it on your end or if I just happened to catch this, so.
[AGENT][NEUTRAL] Well, they do an audit, um, they, they do audits, uh, but, um,
[AGENT][NEUTRAL] It looks like this one was not caught. So now that it has been caught and, and thank you for letting us know, um we will uh
[AGENT][NEUTRAL] Um, it looks like this was just done, thankfully. Uh, so what we can do is we can get this fixed very quickly, correctly today, but no, sir, you do not know that. That is, that is a different claim for a different insured, and what it is is that it was just that, uh, when it, when it went through the system, it encoded wrong and that is why that happened. Um, it doesn't happen often, but when it does, we do have a way to fix it.
[CUSTOMER][NEUTRAL] Now would there be
[CUSTOMER][NEUTRAL] Yeah, would there be anything on this claim that was processed or sent to my primary care provider on based that it was OK, I just wanna make sure I didn't need to.
[AGENT][NEUTRAL] No, sir.
[AGENT][NEGATIVE] Not at all.
[CUSTOMER][NEUTRAL] Well, so
[AGENT][NEUTRAL] Yeah, this error is entirely uh with us and um in our system, which we will be correcting, and then we are letting the providers know, uh, in this case, uh Dr. [PII], and then we are also contacting on the, on behalf, of course, of the other insured, we'll be contacting Nicholas Children's Hospitals to make them know that we will be getting this but that is what we are doing. It's, yeah, so on on your part, your, your major medical notes sir nothing has been um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They didn't have our ID, you know, as far as stolen identity, so.
[AGENT][NEUTRAL] No, sir. No, no. This was, this is our fault when we were encoding it when we send it through the system. Um, it was just that two digits that were, that were wrong and it just sent everything through the and, and when those things happen, um, you know, that's, but this like, uh, like I said, this just happened and that's why it hasn't, you know, it wasn't caught by audit yet, but, um, but yes, uh, yeah, there's nothing with your major medical concern, and you won't be getting this bill.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I don't
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right I appreciate your help on the matter.
[AGENT][POSITIVE] OK, well, thank you very much for contacting ATL sir. We will be getting this fixed. You have a very good weekend. Thank you for calling us sir.