AccountId: 011433970860
ContactId: 0a24f40f-e666-45e3-89af-ae7730665368
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 252699 ms
Total Talk Time (AGENT): 110775 ms
Total Talk Time (CUSTOMER): 84160 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/0a24f40f-e666-45e3-89af-ae7730665368_20250623T13:25_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from SSM Health. I need to know the reason for the client.
[AGENT][NEUTRAL] OK, sure, I can assist you with claims, Miss [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure, just a moment.
[CUSTOMER][NEUTRAL] One second please callback number is [PII].
[AGENT][NEUTRAL] Sure
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Sure. The policy number is 02556232.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Mm, yeah, sure.
[CUSTOMER][NEUTRAL] Patient name is uh [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] you're asking for the same.
[AGENT][NEUTRAL] OK, thank you and may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah sure.
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total bill amount is $295 even.
[AGENT][NEUTRAL] OK, so that's [PII] for 295.
[CUSTOMER][NEUTRAL] Mhm, yeah.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for you. And for future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let's see, it looks like the claim was denied, and the reason for the denial is that office visits are not covered by the policy under the member's plan.
[CUSTOMER][POSITIVE] Thank you so.
[CUSTOMER][NEUTRAL] OK, just a moment, let me check on that.
[AGENT][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] The office visits are noncovered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But uh primary use is paid under this claim.
[AGENT][NEUTRAL] Yes, we are the secondary. We're secondary supplemental plan to the major medical.
[AGENT][NEUTRAL] An office visits are not covered under the member's plan with us.
[CUSTOMER][NEUTRAL] OK. Uh, can we build this to patient?
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't have any contractual involvement on the remaining of the claim.
[CUSTOMER][NEUTRAL] Uh, I just need to know whether it is a patient responsibility or not.
[AGENT][NEUTRAL] Again, we are the 2nd.
[CUSTOMER][POSITIVE] It's uh it's patient will be right.
[AGENT][NEUTRAL] Well, we are the secondary. We're not the primary, we're the secondary, so, um, any remaining balance is gonna be up to the provider's discretion. Either they can go back to the primary EOB and see where what was it applied, or they can go ahead and make their own decision. We don't make that decision because we're just secondary, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. If they said it was uh patient responsibility, then we can go to the patient, right?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] You can check and see if that's what the requirements are. Again, I cannot tell you how to what to determine.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] OK. May I get the patient plan?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] May I get the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] Your name?
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] OK, just a moment. Let me check, uh, one second.
[AGENT][NEUTRAL] Mhm, sure.
[CUSTOMER][NEUTRAL] There's a uniform.
[CUSTOMER][NEUTRAL] 7168.
[CUSTOMER][POSITIVE] Exactly
[CUSTOMER][POSITIVE] OK, thank you so much for giving this information bye bye take care.
[AGENT][POSITIVE] You're welcome. Yes, sir. Thank you for calling APM.