AccountId: 011433970860
ContactId: cc3cbb27-da96-4fa1-9307-9041e639c49a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 290779 ms
Total Talk Time (AGENT): 194608 ms
Total Talk Time (CUSTOMER): 95826 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/cc3cbb27-da96-4fa1-9307-9041e639c49a_20250408T21:32_UTC.wav
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[AGENT][NEUTRAL] Contacting ATL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Good afternoon. I'm calling because um
[CUSTOMER][NEUTRAL] I missed something in the mail that I just found last night and it's regarding, um, I was in the hospital uh in October of last year and uh this is a letter that you were requesting some information, but I'm not sure what this means.
[AGENT][NEUTRAL] OK. Um, well, let's look it up and, and what is your policy number, please?
[CUSTOMER][NEUTRAL] 02230003.
[AGENT][NEUTRAL] Thank you. If I could just verify your name and date of birth and the phone number, please.
[CUSTOMER][NEUTRAL] [PII]. My date of birth is [PII] and my cell phone number is [PII].
[AGENT][POSITIVE] I do appreciate that. Thank you. So it looks like um
[AGENT][NEUTRAL] The hospital sent us a claim uh for us to pay for a hospital visit.
[AGENT][NEUTRAL] And what we have asked for is the explanation of benefits from your major medical so that we will know what your deductible, co-payment or co-insurance is. Now, this is, this is actually a notice to your um to the provider, um, Mercy Hospital. Um, so what we're looking for is, is for your Florida, uh blue, um, explanation of benefits for that data service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, when they return, when they, uh, give that to us, what we'll do.
[AGENT][NEUTRAL] And process that claim, but that is what has happened with this. uh, we have to send you a notice now that someone has uh filed a claim against your um.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Against your insurance, but this is for the uh for the provider to let us have that explanation of benefits so that we can finish processing the claim.
[CUSTOMER][POSITIVE] Yes, of course.
[AGENT][NEUTRAL] So that that's really all that is.
[CUSTOMER][NEUTRAL] OK. Is that something?
[CUSTOMER][NEUTRAL] Is that something that I can assist you get from them? I mean, I, I understand the process because when I was hospitalized, obviously, I provided my primary insurance and you guys the gap insurance.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] But I just wanted to make sure things get processed and if I can help get you the information you need I'll be happy to to do that.
[AGENT][NEUTRAL] Well, if you have the explanation of benefits from that date of service, um, because that is what we are requesting, um, that is, that is really what we're looking for in order to, to finish this and then, um, what would end up happening is if you do submit that to us.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um, finish processing the claim, uh, the, the benefit to the, um.
[AGENT][NEUTRAL] To the provider
[CUSTOMER][NEGATIVE] And I'm sorry, you're, you're, you're cutting off. I don't know if we have a void, um, phone connection, but I'm, I'm like missing half the stuff you're saying. I apologize.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Oh, I'm sorry. Yes, no, I, I apologize. So what we're, what we're looking for is that explanation of benefits, and then once we receive that, um, then we will go ahead and process the claim to the provider. So if, if you have that explanation of benefits for that period of time, you could submit it to us. Otherwise, we would, um, we would just wait for the provider to, to give that to us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, and I don't have that. So is that something that Mercy Hospital has to provide me and the benefits would be the treatment they provided while I was hospitalized? Is that what we're looking for?
[AGENT][NEUTRAL] Well, no, it's, what it is is it's, it's your major, it's, it's your um your uh primary insurance, uh, which is, I believe it's Florida Blue, is that correct?
[CUSTOMER][NEUTRAL] OK. So Cigna.
[AGENT][NEUTRAL] Yeah, Cigna, excuse me. So.
[CUSTOMER][NEUTRAL] No, this was Cigna. Cigna.
[AGENT][NEUTRAL] OK, so what, um, so what you would need or what would need to happen is, uh, that you turn this in um for a claim to be filed with Cigna.
[AGENT][NEUTRAL] And they would have what is called an explanation of benefits, basically how they process the claim, and they would put so much of the of the of the charges towards your deductible, co-payment or co-insurance. So that is what we're looking for, um, and if you have that explanation of benefits from Cigna, that would be great. You can submit that to us. Otherwise we wait for the provider to um to contact Cigna to get that for us.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And, and they can do that. They, yeah, and then uh they will, they will submit that to us. We will find out how much the deductible co-payment or co-insurance is, and then we can go ahead and process that claim, but that is what is way this, that's what this is pending for is, is that. So, uh, you can, you can provide it to us. They can provide it to us, but just as long as we get it, uh, then we can, we can finish processing the claim.
[CUSTOMER][NEUTRAL] OK. I understand.
[CUSTOMER][POSITIVE] Oh good.
[CUSTOMER][POSITIVE] Well thank you for your help. What I'll do is I'll reach out to Cigna and see if they can send me a copy becaus[PII], I don't have it, but I'll, I'll ask for it.
[AGENT][NEUTRAL] OK, yes, they should be able to provide that to you and they, they also have an online service center if you wanted to get it that way. Now, is there anything else at all that I can help with?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] No, that was it. I appreciate your assistance. Have a good rest of your day.
[AGENT][NEUTRAL] OK, thank you for contacting AP have a