AccountId: 011433970860
ContactId: 1e18f1b2-63dd-4dfa-87e3-6d3b405c87b4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 240660 ms
Total Talk Time (AGENT): 88822 ms
Total Talk Time (CUSTOMER): 107641 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/1e18f1b2-63dd-4dfa-87e3-6d3b405c87b4_20250313T19:41_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good afternoon. My name is [PII]. I'm calling in regards to claims for a member.
[AGENT][NEUTRAL] OK, well, I'll be more than happy to help you with the claims and you said your name is [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, and Mr. [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02135066
[AGENT][NEUTRAL] And that was 02135066?
[CUSTOMER][NEUTRAL] 5066.
[AGENT][NEUTRAL] All right. And can you verify the member's first and last name for me, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] [PII] bill amount is 178.
[AGENT][NEUTRAL] All right, thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim? This might be it.
[CUSTOMER][NEUTRAL] Pre Preston City physician.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 34063007.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the policy provides no benefits for treatments or conditions other than listed in the policy.
[CUSTOMER][NEUTRAL] OK, so it's preventive visit is not covered under the patient plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, um, I have another question. Just give me one moment.
[AGENT][NEUTRAL] Sure. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Let me make sure that's for the right line. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because I wanna, I wanna ask you another question. I want, I wanna, um, no coronation of benefits. I wanna know if y'all primary or y'all secondary insurance for Caitlin. OK, so that is the big, um, that's, that's probably gonna be another thing anyway because they sent the claim to y'all primary besides, um, sending the claim to the other insurance. So what I'll do is, I know it's kinda, I know it's kindly timely because what's y'all timely time status?
[AGENT][NEUTRAL] We're secondary.
[AGENT][NEUTRAL] Second,
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] We don't have one. As long as the policy is active on the data service, you can file at any time.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Oh, that's good. Um, that's a good thing to do. So what I'm gonna do is, um, possibly may not get back to y'all or not, but, um, I'm gonna go ahead and send submitted to primary because I noticed I kind of thought that y'all was secondary under the coverage, but I want to verify anyway because claim did go to y'all as primary. So I'll notate that on the account as well and I'll resubmit the claim for processing. And when you get a minute, let me get your last initial and and a reference number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, so the first initial to my last name is [PII].
[AGENT][NEUTRAL] There's no call reference number, but you can use my name in today's date.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK, thank you so much for the information and you have a wonderful day. Enjoy.
[AGENT][NEUTRAL] You also [PII], was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, ma'am, that will be it.
[AGENT][POSITIVE] All right, thanks for calling APL.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.