AccountId: 011433970860
ContactId: 0f8ec4c2-d639-4e7d-a5f9-e26c9fb60fe1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 559059 ms
Total Talk Time (AGENT): 179787 ms
Total Talk Time (CUSTOMER): 107247 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/0f8ec4c2-d639-4e7d-a5f9-e26c9fb60fe1_20250618T18:45_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII], I'm calling from provider office upon checking claim status.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's the direct line.
[CUSTOMER][NEUTRAL] Find a way
[CUSTOMER][NEUTRAL] Is there a claim?
[AGENT][NEUTRAL] And may I have um the name of the facility you're calling from from my notes, Mister [PII]?
[CUSTOMER][NEUTRAL] Eon general
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] It's Teraon General M.
[CUSTOMER][NEUTRAL] Teabon general.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, may I have the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 214-822-27.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $665 even.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] If I find this claim and that was [PII].
[CUSTOMER][NEUTRAL] Ma'am, can you repeat once again?
[AGENT][NEUTRAL] You said it was for [PII]?
[CUSTOMER][POSITIVE] [PII], yes, that's correct.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] One moment, let me pull this up here.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] I'm still waiting on the system, bear with me.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So we have processed the claim on [PII].
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And the claim was denied, indicating that benefits are payable only if major medical insurance provides benefits.
[CUSTOMER][NEUTRAL] Ma'am, can you repeat one second please? I can't hear your voice.
[AGENT][NEUTRAL] Benefits are payable.
[AGENT][NEUTRAL] Only if major medical insurance provides benefits.
[CUSTOMER][NEUTRAL] Pay benefits are payable?
[AGENT][NEUTRAL] Only
[AGENT][NEUTRAL] If major medical insurance provides benefits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Benefits are payable only major insurance provides benefits.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] May I know the pair?
[AGENT][NEGATIVE] Wish payer.
[AGENT][NEUTRAL] Mr. [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am. I'm there.
[AGENT][NEUTRAL] What information are you asking for? You said may I provide pay or what payer or what information are you trying to get.
[CUSTOMER][NEUTRAL] Actually said that benefits are payable only. Major insurance provides benefits and who is the payer?
[AGENT][NEUTRAL] Right. Who's the major medical?
[AGENT][NEUTRAL] Because we're talking about the major medical, not the payer, but the major medical. OK, bear with me just a second.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, major medical.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I'm waiting on the documents. OK, so Blue Cross Blue Shield is the major medical, so we will pay if they pay, we don't pay if they don't pay. We're the secondary.
[CUSTOMER][NEUTRAL] Actually, BCBS pays the amount, remaining amount you will pay.
[AGENT][NEUTRAL] Um, the amount applied towards the deductible co-payment and coinsurance is the amount that we will pay after the major medical.
[CUSTOMER][NEUTRAL] What is the amount, ma'am? It's the co-pay amount?
[AGENT][NEGATIVE] I'm not sure because Blue Cross Blue Shield indicated that they did not pay, so if they don't pay, we don't pay. Everything in the documents is empty, it's zero out.
[CUSTOMER][NEUTRAL] OK, ma'am. Could you hold for a moment, please?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Ma'am, I need for this claim.
[AGENT][NEUTRAL] OK. What is the fax number?
[CUSTOMER][NEUTRAL] Yeah, it's uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, you said [PII]?
[CUSTOMER][POSITIVE] Yes, ma'am, that's correct.
[AGENT][NEUTRAL] OK. To what attention?
[CUSTOMER][NEUTRAL] Yeah, my name.
[AGENT][NEUTRAL] [PII], OK, alright, do you mind holding for me while I send this out to you while I got you on the line.
[CUSTOMER][NEUTRAL] Ma'am, may I know the claim number, please?
[AGENT][NEUTRAL] Sure, that's 354-026-1.
[CUSTOMER][NEUTRAL] 354-0261.
[AGENT][NEUTRAL] 354-026-1. That is correct.
[CUSTOMER][NEUTRAL] Claim number.
[AGENT][NEUTRAL] That is the claim number.
[CUSTOMER][NEUTRAL] Yeah, ma'am. Could you hold for a moment, please?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Ma'am, thank you for the information. May I know the call reference number?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] Ma'am, may I know your good name, please?
[AGENT][NEUTRAL] Sure, that's [PII], last [PII] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, [PII] last [PII]
[CUSTOMER][NEUTRAL] I can't hear your voice. Can you repeat once again, please?
[AGENT][NEUTRAL] Sure, that's [PII]. That's initial [PII].
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK ma'am. Thank you for the information. Have a nice day.
[AGENT][POSITIVE] Yes ma'am. Thank you for calling ATL. Byebye Mr. [PII].