AccountId: 011433970860
ContactId: 005643c7-7224-48e7-a5f5-c4a099d93a7a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 386989 ms
Total Talk Time (AGENT): 149718 ms
Total Talk Time (CUSTOMER): 127671 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/005643c7-7224-48e7-a5f5-c4a099d93a7a_20250505T14:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling. Excuse me. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm [PII] calling from provider's office regarding our claims.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status. Is that correct?
[CUSTOMER][POSITIVE] Yeah, sure, got it. Mhm.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII] with an extension of [PII].
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] Of only one claim.
[AGENT][NEUTRAL] OK, and what is that member's policy number, please?
[CUSTOMER][NEUTRAL] Your member's policy number is 02505754.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, number 8.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] It's first name is [PII]. The last name is [PII].
[CUSTOMER][NEUTRAL] [PII] and the last date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the data service and total bill amount, please?
[CUSTOMER][NEUTRAL] The of service is going to be [PII] with the bill amount of $3,352 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so this claim was received.
[AGENT][NEUTRAL] The received date was [PII] and it was processed on [PII].
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 4419.
[AGENT][NEUTRAL] And the remark code for the denial on this claim, [PII] states.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Benefits are payable only if your major medical insurance provider provides benefits. If this claim is later paid by your major medical insurance, please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] OK, you're stating that uh you need the primary you be to process the claim.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits with those remarks on it that I just read to you, you can print that directly now that you have the claim number from our portal which is located at [PII].
[CUSTOMER][NEUTRAL] OK, you stating that the services are not covered because
[CUSTOMER][NEUTRAL] Um, actually,
[CUSTOMER][NEUTRAL] I just wanted to confirm, you need, uh, you're stating that uh the APL is secondary, so you haven't issued any primary information details, the primary pay details.
[CUSTOMER][NEUTRAL] It will be, mhm.
[AGENT][NEUTRAL] We do not, correct, the states that benefits are payable only if the major medical insurance provider provides benefits.
[AGENT][NEUTRAL] If the claim is later paid by the major medical insurance, please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] OK, may I know how can I need to submit? How can I need need to submit this primary OB is it through fax or through or else we need to defend the claim again with the primary information.
[AGENT][NEUTRAL] It can be mailed or faxed mailed.
[AGENT][NEUTRAL] No, you, no, we only need the explanation of benefits from the primary insurance and our claims fax number is 877.
[AGENT][NEUTRAL] 3659423 attention claims department.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Attention claims department.
[AGENT][NEUTRAL] Yes, sir. Uh-huh.
[CUSTOMER][NEUTRAL] OK, you're stating that you need the only primary UB primary insurance be to process the claim, and you are suggesting to submit this primary insurance C will be through fax. The fax number is [PII]. Atten claims department, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just asking.
[AGENT][NEUTRAL] And is, yes, and is there anything else that I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Could you, uh, could you please, uh, I just wanted to make, uh, confirm the claim number. The claim number is 3584419. Am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Thank you. In this case, could you please help me the qual reference for this claim, and can you spell your name with the last name for documentation purpose.
[AGENT][NEUTRAL] My name and today's date would be your call reference number. My name is [PII].
[CUSTOMER][NEUTRAL] Thank you, [PII]. OK, I will definitely submit a copy of UB. I will definitely submit a copy of requested UB primary fax. The fax number I just wanted to confirm [PII]. Am I right?
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] OK, great.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Thank you. That's all the information I need. Thank you for assistance. Bye for now.
[AGENT][POSITIVE] OK, well then, thank you. You're welcome and thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Bye bye.