AccountId: 011433970860
ContactId: 09d5ab7b-4fc3-49d8-ac11-d94e7af60813
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 242580 ms
Total Talk Time (AGENT): 125661 ms
Total Talk Time (CUSTOMER): 77488 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/09d5ab7b-4fc3-49d8-ac11-d94e7af60813_20250529T20:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes ma'am. Uh, I got a letter from y'all, uh, it's an explanation of benefits. I have a policy number and a reference number. Do I need to give that to you?
[AGENT][NEUTRAL] Yeah, let me pull that up. Start with the uh policy number if you have that.
[CUSTOMER][NEUTRAL] Yes, I do 02144720.
[AGENT][POSITIVE] All right, thank you so much. Let me pull this up.
[AGENT][NEUTRAL] And then if I could just verify, please, your first and last name?
[CUSTOMER][NEUTRAL] Uh [PII]
[AGENT][NEUTRAL] Thank you, Mr. [PII]. And then, can, what's the reference number that you have?
[CUSTOMER][NEUTRAL] OK, it's 02144720.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then lastly for just verification, I will need to get your date of birth and address, please.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then my address is [PII].
[AGENT][POSITIVE] Alright, thank you so much.
[CUSTOMER][POSITIVE] You're Welcome.
[AGENT][NEUTRAL] Let me pull up this last claim, I see.
[AGENT][NEUTRAL] OK, so does the explanation of benefits that you have, Mr. [PII] have any sort of claim number on it that ends in 1941?
[CUSTOMER][NEUTRAL] Uh, 1941, yes ma'am, 3601941, yes ma'am.
[AGENT][NEUTRAL] OK, so it looks like it was a claim submitted by Graham Young County EMS. It was a date of service of [PII]. Um, it looks like they submitted the claim on your behalf since we're the secondary. Um, it reads that the claim was denied just because it looks like we didn't see that major medical paid anything.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, and so or provides benefits, so that's why we were sending you that explanation of benefits.
[CUSTOMER][NEGATIVE] So do I need to call my major medical, uh, you know, who I had my major medical through and ask them why did they cover it?
[AGENT][NEUTRAL] Well, if this
[CUSTOMER][NEUTRAL] Or I wonder if
[AGENT][NEUTRAL] Yeah, I don't know. Are you getting any sort of bills for this particular EMS service that was provided back last year, or?
[CUSTOMER][NEGATIVE] Yeah, I am from the, the ambulance service, but I've never gotten anything from uh my my uh Blue Cross Blue Shield, my major medical. They never sent me anything. I'm, I wonder if it never got turned into them and it just got turned into y'all.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It may
[AGENT][NEUTRAL] Yeah, it may have. So yeah, I would start there, Mr. [PII], I would call Blue Cross Blue Shield and um ask them what's going on with that, and then if they
[CUSTOMER][NEUTRAL] Or what I could do is call, go ahead.
[AGENT][NEUTRAL] Uh, no, no, no, go ahead.
[CUSTOMER][NEUTRAL] Well, I wonder if I just call the ambulance people and ask them if, uh, if, uh, well, I guess Blue Cross and Blue Shield would know if they had any record of it.
[AGENT][NEUTRAL] For sure, for sure. And if the claim was denied, then find out why, um, or if it was never received. If it was never received, then I would contact the ambulance people and say, hey, my major medical is Blue Cross Blue Shield. Can you please, you know, submit the bill to them first? Yeah, yeah, yeah, and then send it back to us. Yeah.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Send it to them. Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, OK, I'll call them thank you so much I appreciate it.
[AGENT][POSITIVE] My pleasure, sir. Have a good day.
[CUSTOMER][NEUTRAL] You too bye.