AccountId: 011433970860
ContactId: dbb91851-ed4e-4eee-a5fd-d96b2a86447e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 272040 ms
Total Talk Time (AGENT): 89055 ms
Total Talk Time (CUSTOMER): 128463 ms
Interruptions: 0
Overall Sentiment: AGENT=2.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/dbb91851-ed4e-4eee-a5fd-d96b2a86447e_20250218T21:56_UTC.wav
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[AGENT][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][NEUTRAL] Doing well thank you. I have got a provider on the line who's calling regarding a claim um it's stating that uh the primary insurance paid the full benefits so there wasn't anything payable and she's saying that from what she has that there was a remaining balance so she wants to review make sure that what was submitted was accurate.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, are you ready for the policy number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, it is 01897871.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it is for part 2.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, do you have that claim number?
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] OK, it's 3,549,630.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then her name is?
[CUSTOMER][NEUTRAL] Uh, the provider is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And a good callback.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Thank you. I'm ready.
[CUSTOMER][POSITIVE] Alright appreciate it thank you bye bye.
[AGENT][POSITIVE] You're welcome bye bye.
[AGENT][POSITIVE] Hi, [PII], this is [PII], and I'll be happy to assist you with the claim status. How are you today?
[CUSTOMER][POSITIVE] Hi [PII] good how are you?
[AGENT][POSITIVE] I'm great, thanks for asking. So I am looking at claim number.
[AGENT][NEUTRAL] 3,549,630 in which we processed and denied as looks like the primary insurance paid in full.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me see. I'm gonna get the claim pulled up and if you have a different EOB, you can just fax it over to us for reconsideration.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] I do apologize, the system is extremely slow.
[CUSTOMER][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] OK, so it looks like the total bill is $41,082.20.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] There is no co-pays, coinsurance, and or deductibles on this one.
[AGENT][NEUTRAL] So if you have one that shows co-pays, coinsurance, and our deductibles, you can fax it over for reconsideration.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Um, yeah, or no.
[CUSTOMER][NEUTRAL] Says the coinsurance is 0.
[CUSTOMER][NEUTRAL] Does member not enrolled in Medicare, so I'm wondering.
[AGENT][NEUTRAL] So on this one, it looks like it's from Aetna.
[CUSTOMER][NEUTRAL] Yes, so do you see where Aetna paid 156,860?
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] And you guys are her secondary insurance, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So, I'm thinking.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Because it's not really.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Called the payer, spoke with [PII], who stated the remaining balance is patient responsibility due to not being enrolled in Medicare. So it looks like Aetna only paid that 156,860 is because they said maybe the patient wasn't enrolled in Medicare.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] We would not pay off of Medicare. We're always gonna be secondary. So we would pay off Aetna.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Aetna.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] And there's no coinsurance or deductible, so I think then that's patient responsibility. So, OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] All right, [PII], well, I just needed uh to talk through that then. Thank you so much for your time.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] [PII], you're so welcome. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] That would be all, thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling American Public Life, [PII]. Have a great evening. Bye-bye.
[CUSTOMER][NEUTRAL] You too. Bye.