AccountId: 011433970860
ContactId: e0e386a1-1921-4749-b60a-b6bfc53d3063
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 624049 ms
Total Talk Time (AGENT): 210006 ms
Total Talk Time (CUSTOMER): 281815 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/e0e386a1-1921-4749-b60a-b6bfc53d3063_20250305T22:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, how you doing? I got a, I got a billing statement from my dermatology billing service.
[CUSTOMER][NEUTRAL] They're saying that the the copay for this office visit on [PII] wasn't fully paid.
[CUSTOMER][NEUTRAL] So they're asking me to pay the copay.
[CUSTOMER][NEUTRAL] Can you check on this?
[AGENT][NEUTRAL] Yeah, do you have your policy number?
[CUSTOMER][NEUTRAL] Let's see here.
[CUSTOMER][NEUTRAL] OK, policy number, that's the outpatient, that's the outpatient number correct?
[AGENT][POSITIVE] Yeah, you can give me that, that works.
[CUSTOMER][NEUTRAL] OK 0250.
[CUSTOMER][NEUTRAL] 566
[CUSTOMER][NEUTRAL] 6363 6s.
[CUSTOMER][NEUTRAL] [PII] 8.
[AGENT][NEUTRAL] And then if I could get your first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then your address please, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And then.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It looks like the email on file is [PII]. Is that still a good email for you also?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me see, do you have a claim number for the denied claim or just the date of service?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, Sierra.
[CUSTOMER][NEUTRAL] I, I have this statement.
[CUSTOMER][NEUTRAL] On this statement I have.
[CUSTOMER][NEUTRAL] No, on the statement they don't have any on the statement from the billing from the billing service I I have like an account number.
[CUSTOMER][NEUTRAL] I got the date of uh the date of service.
[AGENT][NEUTRAL] OK, and it was [PII]?
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I just spoke to Edna.
[CUSTOMER][NEUTRAL] As I said, they
[CUSTOMER][NEUTRAL] They made the payment of the primary.
[CUSTOMER][NEUTRAL] Charge
[CUSTOMER][NEUTRAL] I've been having
[CUSTOMER][NEGATIVE] I've been having issues with this billing service for my dermatologist's office just to give you an idea of what I've been going through a whole year of claims, if you look at my history, a whole year of claims, [PII] was rejected by Aetna because the billing service was not putting the uh the proper medical code with procedure code. It didn't match, so the the claims were being rejected.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A whole year.
[CUSTOMER][NEGATIVE] And then, uh, now they're finally they they're denying me uh medical treatment.
[CUSTOMER][NEUTRAL] But it's not my fault. It's a billing service that I'm putting the putting the proper claims.
[CUSTOMER][NEGATIVE] I have to make so many phone calls, so many complaints.
[CUSTOMER][NEUTRAL] The the billing service HR.
[CUSTOMER][NEGATIVE] And really nobody uh.
[CUSTOMER][NEGATIVE] I guess nobody really nobody really cares to take care of the issue.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEGATIVE] If this billing service is that incompetent, I can't be the only patient that they're submitting wrong claims. That's what I don't understand.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I'm sorry about that, [PII]. So, I do see one claim on file for [PII].
[AGENT][NEUTRAL] Um, it looks like when it was originally submitted to us, the denial reads that your major medical didn't pay anything, so.
[AGENT][NEUTRAL] This plan being your secondary of course would only pay if the primary did, so we need an explanation of benefits from the primary to see what they paid.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hey, I just spoke to him. I just spoke to [PII]. I mean, I mean, is there any way you could contact [PII]? I mean, I just spoke to him.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Can you call, can you contact [PII] while I'm on the phone?
[CUSTOMER][NEUTRAL] To verify?
[CUSTOMER][NEUTRAL] I can give you the number.
[AGENT][NEUTRAL] We need the actual explanation of benefits, [PII], to process the claim. We can't just take a verbal yes the claim was paid unfortunately.
[AGENT][NEUTRAL] So Aetna.
[CUSTOMER][NEUTRAL] OK, so what do you need?
[CUSTOMER][NEUTRAL] What do you need the EOP for [PII]?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, I guess I can pull that up.
[CUSTOMER][NEUTRAL] And I don't know if I can I don't know if I can forward that to you. I don't think I can forward that to you. How, how can I get that to you then?
[AGENT][NEUTRAL] The information can be submitted online. We have a service portal where you can submit claims and manage claims. Um, you can also submit the information via fax or in the US postal mail.
[CUSTOMER][NEUTRAL] OK, let me see here.
[CUSTOMER][NEUTRAL] What's what's the fax number I can fax it to?
[AGENT][NEUTRAL] Uh, the fax number is going to be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, do I need to put attention to anybody or any any department?
[AGENT][NEUTRAL] Uh, Attention claims.
[AGENT][NEUTRAL] And I would write the claim number that you're referencing that the explanation of benefits is for, and I can give you the claim number.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] The claim number is 356-0956.
[CUSTOMER][NEUTRAL] Are you
[CUSTOMER][NEUTRAL] Oh my, say it again, you broke up.
[AGENT][NEUTRAL] 356.
[AGENT][NEUTRAL] 0956.
[CUSTOMER][NEUTRAL] OK, so put that claim number on attached to the uh to the fax.
[AGENT][NEUTRAL] Mhm. Correct, yup.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK if I can't, if I can't, can't send it by online, then I guess I'll try to fax i[PII] to you.
[AGENT][POSITIVE] OK, yeah, that definitely works. You can send it via fax and that looks like the information that was needed for that. Um, I don't see anything else at this time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, but how, how, how do you normally get that information?
[AGENT][NEUTRAL] If your provider is submitting claims on your behalf, so whoever you're going to see the physician.
[AGENT][NEUTRAL] They should be billing your primary insurance first and then billing as secondary.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so can I contact the provider and have them, would, would they be able to get, get the ELB or no?
[AGENT][NEUTRAL] I mean, they should have an explanation of benefits from your primary insurance, yes.
[CUSTOMER][NEUTRAL] But I, what I, what I'm asking is, is there a way that I can contact them, have them forward that information to you?
[AGENT][POSITIVE] Yes, you should be able to do that, absolutely.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEGATIVE] OK, let me see if I can try that. I, I mean, I don't, I don't know what to tell you this, this billing company is, uh, is, is they, they're running circles. They're running circles. I mean they're, they're so incompetent they can't do, they can't do. I've had a whole year of claims, miss, a whole year from January.
[CUSTOMER][NEGATIVE] That were rejected because this company.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEGATIVE] I'm gonna try to call HR again, but this is, this is ridiculous. Let me try this route. Let me try this route if I can. I'll try to fax it to you. I'm just trying to get it to you as fast as I can, so I'm gonna ask them to see if I can uh.
[AGENT][NEUTRAL] Yeah, I mean,
[AGENT][NEUTRAL] If they're not submitting the claims and doing it in the way that you need it to be done, you can
[AGENT][NEUTRAL] Do them yourself it's not ideal just because it takes time of course to do but if you go to our website, I mean you could submit all the claims yourself, but you would have to wait until your primary processes it before you could submit the claim to us.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, but see, that's, that's, that, that's the thing is I'm the patient. Isn't that their job? Why am I doing their job?
[AGENT][POSITIVE] I can't disagree with, I can't disagree with that. I'm just letting you know that that's another option. I, I totally see where you're coming from.
[CUSTOMER][NEUTRAL] You understand?
[CUSTOMER][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, let me, let me try. Let me try, let me try that around now. I'm gonna try out to find a fax and if I got, see if I can fax it to you, but that what I don't understand is this is not gonna be the first claim. I got, I, I go that our office, uh, for laser treatment 2 times a month.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So if there's that incompetence, they're gonna be doing this all the time. This is ridiculous that I got to deal with this.
[AGENT][NEUTRAL] Yeah, I mean, I would just let them know that that's pretty standard with a secondary insurance, which is what we are for you, that we need to know what your primary insurance paid because that's the purpose of the secondary is to cover what the primary doesn't. And so we're not going to pay anything unless we have documentation showing what they paid.
[CUSTOMER][NEUTRAL] But let me
[CUSTOMER][NEUTRAL] We have.
[CUSTOMER][NEGATIVE] I know, but I just spoke to, uh, I just spoke to the billing service because that's the first person I called, and for whatever reason they're telling me that my copay was $500 some dollars. I said copays are never that expensive. I'm not gonna be $500 some dollars.
[CUSTOMER][NEUTRAL] So I, you know, you see, you see where I'm coming from?
[CUSTOMER][NEGATIVE] They they're so incompetent that they're inconsistent.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] That's what I'm dealing with.
[CUSTOMER][POSITIVE] You know, alright, let me try let me try that route, miss. Thank you for your help.
[AGENT][POSITIVE] You're welcome, [PII]. Have a good day.
[CUSTOMER][NEUTRAL] You too.