AccountId: 011433970860
ContactId: a9d7dfa0-489c-4a21-b699-e6b76df4ccdd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 695229 ms
Total Talk Time (AGENT): 217072 ms
Total Talk Time (CUSTOMER): 142009 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/a9d7dfa0-489c-4a21-b699-e6b76df4ccdd_20250611T15:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII].
[AGENT][NEUTRAL] How can I help you?
[CUSTOMER][NEUTRAL] Hi. Um, my name is [PII]. I'm calling from Carioflex Therapy. I was calling to check on some medical claims.
[AGENT][NEUTRAL] OK, yeah, I can check some claims for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, it's 02212155 M like Mary 18.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Um, [PII], [PII].
[AGENT][NEUTRAL] OK perfect thank you for verifying that and then what was the date of service for this claim?
[CUSTOMER][NEUTRAL] OK, I had a few. The first was [PII].
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and then uh that bill amount please.
[CUSTOMER][NEUTRAL] $760.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] Alright [PII], uh, what was the tax ID for this provider please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you one moment you did say that was beginning on [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, bear with me just a moment. I was thinking about it.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so I did find this claim.
[AGENT][NEUTRAL] Uh, [PII], it looks like.
[AGENT][NEUTRAL] Let's see, it does state that if, uh, so these benefits as this is a secondary medical policy, the benefits are only payable if their major medical insurance uh provides benefits. So if they did, then we would need that explanation of benefits showing what they paid to uh co-pay deductible or co-insurance.
[CUSTOMER][NEUTRAL] OK, so are you saying you you don't have the EOB there?
[AGENT][NEUTRAL] Correct, um, if they did contribute anything to copay deductible coinsurance, we did not receive that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm just trying to look. I know you guys are, I do have you listed as secondary um.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] I don't believe that they made a payment, but they placed it as a patient responsibility.
[AGENT][NEUTRAL] OK, so if there, no, ma'am, so this policy will only pay if the major medical does.
[CUSTOMER][NEUTRAL] Would you guys cover that?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So if they don't make a payment even though they're stating it's a patient responsibility, you guys don't cover that.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Normally that's the normally the secondaries do, but it's, is that just because the type of policy it is?
[AGENT][NEUTRAL] Right, this policy is very, yes, this policy is very dependent on uh whoever they have as major medical so if they're not willing to contribute anything this policy will not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll make a note of that. OK, alright, I just had a few other.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Dates also just to make sure you have them and you will send us an ELB or no? OK.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Um, I can, yeah, uh, did you want me to fax them to you?
[AGENT][NEUTRAL] Oh, you should receive them in the mail, but um I can go ahead and send them.
[CUSTOMER][NEUTRAL] Um, if you could, when, yeah, when, when were they processed? Yeah, when were they processed? What day was, was it processed? Just OK.
[AGENT][NEUTRAL] Let's take a look so this claim.
[AGENT][NEUTRAL] This last one was processed on [PII].
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] But you should be getting them in the mail, but I can go ahead and fax them to you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What was that fax number for you?
[CUSTOMER][NEUTRAL] Um, it's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me read that back, make sure I heard that correctly. That was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alright, I will go ahead and get that sent now. um, what was that next date of service?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, and then that bill amount please.
[CUSTOMER][NEUTRAL] $560.
[AGENT][NEUTRAL] 560. OK, thank you one moment.
[AGENT][POSITIVE] Bear with me just a moment. I appreciate your patience.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, there we are.
[AGENT][NEGATIVE] So this one we simply did not receive a copy of the primary EOB.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] We'll go ahead and send that
[AGENT][NEUTRAL] OK, and then I will fax this one to you as well. OK, um, let's see, give me just a moment.
[CUSTOMER][NEUTRAL] Alright, I did have a couple other dates.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, alrighty, you could go ahead and give me that next data service.
[CUSTOMER][NEUTRAL] OK, it's [PII], and that one's $280.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 280. OK, one moment.
[AGENT][NEUTRAL] Alright, I apologize. It looks like this we received this one, more than once that the register as a duplicate, so let me try to find that original.
[AGENT][NEUTRAL] OK, so I did find that original um so this one we didn't receive a copy of the primary EOB either.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, and then whenever you're ready.
[AGENT][NEUTRAL] OK, yes, one moment please.
[CUSTOMER][NEUTRAL] OK, OK, sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, uh, and then you can go ahead with that next one.
[CUSTOMER][NEUTRAL] OK, it's um [PII], and it's $560.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 560. OK, thank you one moment.
[AGENT][NEUTRAL] Alrighty, uh, so this one is the same, uh, we also did not receive a copy of the primary EOB.
[CUSTOMER][NEUTRAL] All right, and then one last one.
[CUSTOMER][NEUTRAL] When you're ready and this one actually we had to fax in the EOB.
[AGENT][NEUTRAL] OK, alrighty, give me just a moment.
[CUSTOMER][POSITIVE] So hopefully you have all that.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, uh, you can go ahead with that date of service.
[CUSTOMER][NEUTRAL] OK, it's [PII], and it's $280.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] OK, so this one is showing the same message as the first, so stating that benefits are only payable if major medical provides benefits. So we did receive an EOB but not one that shows if anything was contributed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sounds good alright I'll let her know that alright, I appreciate your help.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Absolutely you should be getting all of those EOBs here pretty shortly and was there anything else I could help you with?
[CUSTOMER][POSITIVE] OK, sounds good.
[CUSTOMER][NEUTRAL] Uh, that was it, thanks.
[AGENT][POSITIVE] Alright well thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too. Good bye.
[AGENT][POSITIVE] Thank you bye bye.