AccountId: 011433970860
ContactId: 9b6a0488-4715-498a-888e-f70a903cfe96
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 439890 ms
Total Talk Time (AGENT): 224369 ms
Total Talk Time (CUSTOMER): 116821 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/9b6a0488-4715-498a-888e-f70a903cfe96_20250205T14:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi. I'm sorry, did you say your name is [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hi [PII], um, I'm calling about a claim that I just became aware of um.
[CUSTOMER][NEUTRAL] That's kind of old and I wanted to see if you could give me some information about it so I can straighten it out.
[AGENT][POSITIVE] I'll be happy to assist you with claim status. May I have your policy number?
[CUSTOMER][NEUTRAL] Thank you, policy number is 021.
[CUSTOMER][NEUTRAL] 40,820
[AGENT][NEUTRAL] And may I have your name and a good callback number?
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[CUSTOMER][NEUTRAL] And my phone number is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII], can you verify your date of birth, your mailing address, and your email please?
[CUSTOMER][NEUTRAL] Yes, my date of birth is [PII].
[CUSTOMER][NEUTRAL] My address is [PII].
[CUSTOMER][NEUTRAL] And my email is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information and do you have a data service or claim number?
[CUSTOMER][NEUTRAL] Um, I have a claim number 3401584.
[AGENT][POSITIVE] Thank you for future reference. You may visit our website at [PII] to check claim status as well.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Looks like this claim processed 15-2024 and looks like it was for South Miami Hospital.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let's see it denied as.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The incorrect EOB. So let me get this pulled up. It looks like the EOB that was attached from the provider did not match. Let me pull it up.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] That's what I have in my notes.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, so it looks like the total bill amount was 739 on [PII].
[AGENT][NEUTRAL] And the ELB.
[AGENT][NEUTRAL] Shows.
[AGENT][NEUTRAL] Deductible amount of $2450.04.
[AGENT][NEGATIVE] So that does not match.
[AGENT][NEUTRAL] What they built
[CUSTOMER][NEUTRAL] What did it show the deductible amount?
[AGENT][NEUTRAL] 245004.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] So that does not match because the charge was only $739.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So we asked for corrected EOB from the provider.
[CUSTOMER][NEUTRAL] Be in South Miami Hospital.
[AGENT][NEUTRAL] Let's see.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Let me double check
[CUSTOMER][NEUTRAL] And they never sent it to you?
[AGENT][NEUTRAL] I'm pulling that up now to verify if we have anything in our system.
[AGENT][NEGATIVE] And it doesn't look like we received anything.
[AGENT][NEUTRAL] From them for that 7:39.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Which is what
[CUSTOMER][NEUTRAL] They needed to send the EOB for for 7:39.
[AGENT][POSITIVE] Correct, yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, what do you suggest I do?
[AGENT][NEUTRAL] Do you have an EOB that matches that data service and that build out from your primary?
[CUSTOMER][NEUTRAL] Um, I guess I would go on to my old insurance and look for that.
[AGENT][POSITIVE] Yes, ma'am. If you have it, you can submit it as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And indicate whether or not you want benefits paid to the provider or paid to yourself.
[CUSTOMER][NEUTRAL] Look for EOB on Aetna.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I just need to search my claims on Aetna for that amount.
[AGENT][POSITIVE] Yes, ma'am. That is, yes, ma'am, that is correct. Let me double check something real quick.
[CUSTOMER][NEUTRAL] 7:39.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 11:27.
[AGENT][NEUTRAL] I see what they did.
[AGENT][NEUTRAL] They actually submitted.
[CUSTOMER][NEUTRAL] Oh, what did they do?
[AGENT][NEUTRAL] The incorrect EOB with the incorrect charges. So, it looks like on [PII], there was a minor surgery for 4804.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] They attach the incorrect EOBs cause this EOB has 739.
[AGENT][NEGATIVE] So what I'll do is I'll write this up. So what they did, they did submit the claims, they just put the incorrect EOBs with the incorrect billing.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So we do have them in-house.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'll go ahead and get this written up and have them separate these ELBs and put them with the correct one.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Because it looks like they did process a charge.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] So it looks like we just need to process the one for 7:39. So you will be receiving, yes, ma'am, you will be receiving an EOB once this claim is processed.
[CUSTOMER][POSITIVE] Oh my gosh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, so I don't need to do anything just wait for that?
[AGENT][POSITIVE] Yes, ma'am, because I did find this you'll be here.
[CUSTOMER][POSITIVE] Oh my [PII], that's wonderful.
[AGENT][NEUTRAL] Yes, ma'am. It looks like the bill amount was 739, the deductible amount was 376.89.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'll go
[CUSTOMER][NEUTRAL] Yeah, that's the amount I owe them.
[AGENT][POSITIVE] Yes ma'am, so I'll go ahead and write this up and send it over.
[CUSTOMER][POSITIVE] Oh my gosh.
[CUSTOMER][POSITIVE] [PII], that's so great.
[AGENT][POSITIVE] So we'll get you taken care of, [PII].
[CUSTOMER][POSITIVE] I appreciate it.
[CUSTOMER][POSITIVE] Oh thank you so much I appreciate it OK thank you have a great day.
[AGENT][POSITIVE] You're so welcome.
[AGENT][POSITIVE] You're welcome. [PII], you as well and thank you for calling American Public Life. Bye-bye.
[CUSTOMER][NEUTRAL] OK bye bye.