AccountId: 011433970860
ContactId: a3be0032-a26d-4ae2-8a5c-842eda9b2e11
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 582450 ms
Total Talk Time (AGENT): 149783 ms
Total Talk Time (CUSTOMER): 136462 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/a3be0032-a26d-4ae2-8a5c-842eda9b2e11_20250218T19:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. My name is [PII], and I'm calling to verify if an um EOB was received.
[AGENT][NEUTRAL] OK, let's take a look. Do you have a policy number?
[CUSTOMER][NEUTRAL] I do. It's um 020.
[CUSTOMER][NEUTRAL] 36914 ML 8.
[AGENT][NEUTRAL] Alright thank you let me pull this up here.
[CUSTOMER][NEUTRAL] And your name is [PII]?
[AGENT][NEUTRAL] And then, uh-huh, and that's [PII]
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] First initial your last?
[AGENT][NEUTRAL] It's gonna be [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] No problem. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] Thank you for that. Let's see here.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK, so it looks like we did get an EOB, um, it looks like it was for date of service just to confirm was [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so it looks like we received the primary explanation of benefits with the claim, however, explanation of benefits received did not list the amount applied towards deductible, co-pay, or co-insurance, so we need to have those amounts to know what the difference is as far as what we would pay.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I don't understand. What do you mean? The one that you received does not specify deductible and co-pay and co-insurance?
[AGENT][NEUTRAL] It does not state the amounts that were applied towards the deductible co-pay or co-insurance. That's what the denial is saying.
[CUSTOMER][NEUTRAL] It's incorrect because I'm, I'm clearly looking at it, so, um, and that's the and that's, that's what an EOB stating the patient responsibility and that's what was sent.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull it up here.
[CUSTOMER][NEUTRAL] So I, I'm not sure if it's a system glitch so it's it's clearly listed on here that I'm looking at.
[AGENT][POSITIVE] OK, I'm happy to pull it up here. Give me just one moment please.
[CUSTOMER][POSITIVE] Alright, thank you.
[CUSTOMER][NEUTRAL] So to be 3 pages.
[CUSTOMER][NEUTRAL] The fax cover and then I believe it's 2 pages of the EOB.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, so I'm looking at the um upload that was done. I do see the 4 pages, but on Aetna patient information, I don't know why everything is blank on our side. There's nothing there.
[CUSTOMER][NEUTRAL] That's weird. Um, so all the pages that you received are blank?
[AGENT][NEGATIVE] Yeah, I mean there's no there's no bill amounts there's no patient name, there's no date of birth, member ID nothing.
[CUSTOMER][NEUTRAL] That is so weird because um
[AGENT][NEUTRAL] I mean we got all 4 pages. I see what you're talking about, but I don't know why, yeah, like there's
[AGENT][NEUTRAL] There's just no diagnosis codes, the co-insurance amount like it says co-insurance amount, but there's no amounts next to it or patient responsibility, so.
[AGENT][NEGATIVE] They just would need to be resent.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] Hm, OK, that's so frustrating, you know. So after we did all that process, this thing has been pending for a while and then now we sent out the um the information that, you know, it's just like.
[CUSTOMER][NEUTRAL] Now you're receiving blank document. That's kind of weird because we send it regular.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] All the, all the, um, I mean, the, the facts were clear.
[CUSTOMER][NEUTRAL] And we received the fax confirmation so uh uh I just kind of puzzled about, you know, you guys receiving the whole document, the, the whole all the pages were blank.
[AGENT][NEUTRAL] Yeah, I apologize for the frustration. I don't know why it would come through that way either. It's very unusual.
[CUSTOMER][NEUTRAL] Oh yeah, yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And, and then the, the, the secondary claim that you received on the UBO4, did you see the patient responsibility um listed on there um as well?
[AGENT][NEUTRAL] Mm, let's see.
[CUSTOMER][NEUTRAL] Or maybe I have to build the patient, maybe they'll go ahead and send out the claim, because that's probably what's gonna happen, and then maybe they take it out with you guys.
[AGENT][NEUTRAL] Let me pull this up and see here. Give me just a second.
[AGENT][NEUTRAL] Yeah it looks like the amount is on this one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so yeah, you know, for the this one that the amounts didn't come through. I don't know, you know, it's up to you guys if you wanna resubmit it or just.
[AGENT][NEUTRAL] The patients submit the claim they can do that also.
[CUSTOMER][NEUTRAL] Yeah, I'm just gonna build the patient. Yeah, I'll be the patient. They'll do it. They'll go with it. It's too much frustration for us trying to collect from the secondary. Alright, well, may I get the reference number please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Call references my name with my last initial and then just today's date.
[CUSTOMER][POSITIVE] All right. Thank you. Have a wonderful day.
[AGENT][NEUTRAL] You're, you too. Bye-bye.