AccountId: 011433970860
ContactId: 9859c724-9db6-4154-942c-05adc7432f7e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 303609 ms
Total Talk Time (AGENT): 149331 ms
Total Talk Time (CUSTOMER): 92511 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=2.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/9859c724-9db6-4154-942c-05adc7432f7e_20250128T18:59_UTC.wav
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[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Who is this? I'm sorry.
[AGENT][NEUTRAL] This is money
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] on the care team. How's it going today?
[AGENT][POSITIVE] Great, how are you?
[CUSTOMER][NEUTRAL] Doing all right thank you. I've got a provider on the line uh calling regarding a claim um the original claim stated we needed the primary EOB. She said she did submit that uh the date that she did I see that, and according to the claim it's just saying the same thing that we need the primary EOB, uh, so we're just kind of double checking to see if what they submitted was sufficient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I tried looking at what they submitted, but I'm gonna be honest, I'm not sure what I'm looking at. It was like I see Aetna on there but.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK, the policy number is 2497505.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it is for part 2. I've got that claim number.
[AGENT][NEUTRAL] OK, 42 and the claim number?
[CUSTOMER][NEUTRAL] It is 353-354-2.
[AGENT][NEUTRAL] And then who am I speaking with?
[CUSTOMER][NEUTRAL] Her name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][POSITIVE] OK thank you I appreciate it.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] All right, bye-bye.
[AGENT][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Hi, [PII], this is [PII]. How are you today?
[CUSTOMER][POSITIVE] Hello [PII]. This is [PII]. Yeah, I'm doing good. Thank you so much for asking. How about you?
[AGENT][POSITIVE] I am wonderful, thank you, and I'll be happy to assist you with the status for the claim. Please be advised that verification of coverage does not guarantee the payment of a claim. So I'll get this pulled up. It is for Janelle, Data Service 792024.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like it processed and primary insurance did not pay. Let me get the image pulled up.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so let's see.
[AGENT][NEUTRAL] So it looks like this was processed as a duplicate.
[AGENT][NEUTRAL] Uh, let me see if we have another claim in house so I can look at that EOB as well.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Are you showing a patient responsibility on this claim?
[CUSTOMER][NEUTRAL] Yeah, by primary.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] OK, so it looks like it came in under claim number 349-8956 and which we denied for the primary EOB and then it looks like under 3533542, they denied that primary did not pay. Now, according to this EOB,
[AGENT][NEUTRAL] I don't see anything applied to the copay coinsurance and our deductible. It states this is a dope. Do you have an EOB that shows copays, coinsurance, and our deductible?
[CUSTOMER][NEUTRAL] Yeah, I do have.
[AGENT][NEUTRAL] Can you fax that over?
[CUSTOMER][POSITIVE] Yes, actually $60 yeah, sure, no problem.
[AGENT][NEUTRAL] Yes, and we'll get this claim reconsidered. We just need the EOB showing patients responsibility.
[CUSTOMER][POSITIVE] OK, sure, no problem.
[AGENT][NEUTRAL] Can you fax it to 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942-3 attention claims and you can reference that claim number.
[CUSTOMER][NEUTRAL] I can fax it to you, but, but I just need to know like we have already submitted primary EOB.
[AGENT][NEUTRAL] And the one that I'm looking at, it was received [PII].
[CUSTOMER][NEUTRAL] So,
[AGENT][NEGATIVE] But it does not show anything applied to the deductible and co-insurance, and it looks like it's actually cut off.
[CUSTOMER][NEUTRAL] 9 December
[AGENT][NEUTRAL] I don't see any co-pays. Yeah, the copay is empty, the deductible is empty and the co-insurance is empty.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] It shows
[CUSTOMER][POSITIVE] OK, sure, no problem.
[AGENT][NEGATIVE] $1000 not payable.
[CUSTOMER][NEUTRAL] I can resubmit that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sure, no problem. I can resubmit that, yeah.
[AGENT][NEUTRAL] OK. Is there
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Uh, no, thank you so much. That's it for today.
[AGENT][POSITIVE] Thank you for calling American Public Life, [PII]. Have a great day. Bye-bye.
[CUSTOMER][POSITIVE] Have a great day bye take care.