AccountId: 011433970860
ContactId: e3557c7c-b400-494f-ae21-cffd8ed8fbdd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 457540 ms
Total Talk Time (AGENT): 289254 ms
Total Talk Time (CUSTOMER): 154821 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/e3557c7c-b400-494f-ae21-cffd8ed8fbdd_20250611T20:38_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. Um, I have a question on the, on the denial of my claim. Can I provide, can I give you the claim number or the policy number?
[AGENT][NEUTRAL] Yes, please. Yes, what is the policy number, please?
[CUSTOMER][NEUTRAL] Uh, which
[CUSTOMER][NEUTRAL] Policy is 02519455.
[AGENT][NEUTRAL] Thank you. If I could just verify your date of birth and the phone number, please?
[CUSTOMER][NEUTRAL] Yes, [PII] telephone number is [PII].
[AGENT][POSITIVE] Thank you very much. And what is the date of service that we're looking for, please?
[CUSTOMER][NEUTRAL] Um, it was for.
[CUSTOMER][NEUTRAL] Uh, no, uh, [PII], I'm sorry, [PII] until [PII].
[AGENT][NEUTRAL] OK, yes, and, uh, OK, so let's see if I can look that up here. OK, so it looks like there's several things that we have um.
[AGENT][NEUTRAL] Now, the uh
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] One of the charges that they're looking for, um, this was for the, uh,
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It looks like a
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like uh for an ECG uh record uh and let's see, OK, so it looks like an echocardiogram, yeah.
[CUSTOMER][NEUTRAL] Yes, ECG.
[AGENT][NEUTRAL] Yes, so what they're looking for for that is the um diagnosis code from the provider. Uh, the provider lets us, uh, will, will have documentation showing uh what the uh or the reason for the echocardiogram, and you can get that from the provider themselves. And so what they will do is they usually will give you walkout papers or they'll have um uh other notes that let us know what, what, uh, why you had that done.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And uh that is what we're looking for for that. And then when we get through with that, and then we'll be fine. Now, the office visit, uh, that would be $250 for the office visit for Doctor [PII], um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That, that is not covered under the policy. Uh, the office visit is not covered, uh, so that's, um, that was what went on with that. Now, the other thing for the, um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] It looks like there was also another echocardiogram, uh, that would have been for $80. Now, on the explanation of benefits, or excuse me, on the paperwork, they're not showing that there was anything that was due on that.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And that's why that wasn't um that's why we don't have anything for that so it looks like you're uh.
[AGENT][NEUTRAL] Your insurance Cigna.
[AGENT][NEUTRAL] Um, didn't leave anything for the deductible, uh, co-payment or co-insurance.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] But on the um on the charge of $610 it's also for an for an echocardiogram or ECG we are looking for the for the um
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Correct
[AGENT][NEUTRAL] Uh, documentation from the provider just letting us know why you had that done. So what they will do is they, they will have physicians notes. Sometimes they will have, um, the documentation that they will provide to you. Unfortunately they won't provide it to us, and that will let us know that information. And then what we'll do is we'll finish processing the claim from there. But that is what it's not denied what it is is it's pending, [PII]. We're just, we're just waiting for that documentation and then we will finish and we will, um, go ahead and and be able to to make that payment out.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, so what is the what is needed is only the documentation, the, the notes, chart notes from the doctor, is that all?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, it's and it just lets us know what.
[CUSTOMER][NEUTRAL] Is it like the result or?
[AGENT][NEUTRAL] Well, no, it's not like the receipt. What it is is that they will give you what is called a walkout paper or it, it tells you what they did that day, but more importantly, they'll tell you why they did it. So if you came in for heart murmur, uh, if you came in for, uh, irregular heart beat or whatever it is, they, they have notes, they, they will have a diagnosis letting us know why you went in for that, and we need that in order to finish the claim. And so once we receive that, then, then we will go ahead and finish processing it. So that is what we're looking at right now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, uh
[CUSTOMER][NEUTRAL] OK, so right now you're looking, we, you need the notes and the diagnosis codes too.
[CUSTOMER][NEUTRAL] Or on the notes it will say that I.
[AGENT][NEUTRAL] Well, it, it's the same thing.
[AGENT][NEUTRAL] Yeah, it's usually the same thing. It usually will tell us exactly what's uh it, it tells us for that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's generally the same thing.
[CUSTOMER][NEUTRAL] OK, so, um, do you guys.
[CUSTOMER][NEUTRAL] Yeah, so do you guys need uh, before, um, when I went to the first visit to the doctor, like the reason why and then when they did the.
[CUSTOMER][NEUTRAL] The ECG and the electrocardiogram result.
[CUSTOMER][NEUTRAL] Or can I just give you just the the very first.
[CUSTOMER][NEUTRAL] Visit when I, when I saw the doctor and then his plan to um to check my heart.
[AGENT][NEUTRAL] It will probably have that that'll probably have that information. Yes, it'll probably have that informa that, that's probably the very first one, where you, where you first went in. It will probably uh list, uh, the, the, um, course of treatment, but the reason why, you know, we're, we're, we are looking for the, usually we'll say something like that they're, we're going to begin this course of treatment because the patient came in with, with the, you know, this is what we suspect is going on. So that's what we're looking for and that's
[CUSTOMER][NEUTRAL] Cause they're
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] That would, that is what uh we need for that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and then let's see what else is needed diagnosis and then do you guys need that diagnostic testing result?
[CUSTOMER][NEUTRAL] Or just a
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] No, just this why you had the test done.
[CUSTOMER][NEUTRAL] Is it the document please
[AGENT][NEUTRAL] Yes, that's why you had the test done would be, would be, yeah.
[CUSTOMER][POSITIVE] I'm so sorry.
[AGENT][POSITIVE] Will be sufficient.
[CUSTOMER][NEUTRAL] OK, so the first visit, it's just the first visit is that's the only thing that you guys need?
[AGENT][NEUTRAL] Uh, yes, that should tell us what we need to know.
[CUSTOMER][NEUTRAL] OK, got it. OK, I think I can request that from my doctor and then I'll go ahead and um is there a fax number or should I go sign up for the portal to.
[AGENT][NEUTRAL] Well, getting it to us through the portal is probably, yeah, getting it to us through the portal is probably the fastest way to do it, [PII], but if you, if you want to fax it to us, that, that way is, is uh good as well. What is the easiest for you. Now our, our fax number.
[CUSTOMER][NEUTRAL] To uh upload the docs.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 877.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] 365 uh-huh.
[AGENT][NEUTRAL] 9423.
[AGENT][NEUTRAL] Or if you would like to go online.
[CUSTOMER][NEUTRAL] 94 2
[AGENT][NEUTRAL] Yes, ma'am. Or if you would like to go online.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To um [PII], uh, you'll you'll need to sign in as a new user.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then if you will just uh all you have to do is it's very fast you just uh create a password and a user code and then you can you can uh send that to us and we get it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Um, very quick.
[CUSTOMER][POSITIVE] OK, OK, and then, OK, got it. OK, I'll go ahead and request it from my doctor and then I'll go ahead and send it to you guys. Thank you so much for your help.
[AGENT][POSITIVE] Well thank you very much for contacting ATO. You have a very good day.