AccountId: 011433970860
ContactId: 20b5d07c-e03a-4d45-959b-cf0f2a9fac7c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 360000 ms
Total Talk Time (AGENT): 175276 ms
Total Talk Time (CUSTOMER): 119867 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/20b5d07c-e03a-4d45-959b-cf0f2a9fac7c_20250414T14:04_UTC.wav
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[AGENT][NEUTRAL] Uh, thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey [PII], I've got a provider on the back line that's trying to get a claim status on a spouse on a meddling policy.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Policy 215.
[CUSTOMER][NEUTRAL] 89
[CUSTOMER][NEUTRAL] 51
[CUSTOMER][NEUTRAL] You're speaking to [PII], and she's calling about [PII]. It's a female the way it's spelled, um, and the callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and I did verify demographics.
[AGENT][NEUTRAL] This [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Good morning, [PII]. How are you doing?
[CUSTOMER][NEUTRAL] Good morning, hon. I didn't know if that was you or not. So I was like, OK, who am I talking to for a minute?
[AGENT][NEUTRAL] I said it sounds like jelly food, but I don't know.
[CUSTOMER][NEUTRAL] Well, it sounded like you and I was like, I, OK, is that her daddy will be like, hey, you're like, oh, it's too early in the morning, girl.
[AGENT][NEUTRAL] Well you
[CUSTOMER][NEUTRAL] Um, but I did verify everything and she just said she was checking on the claim status from back in [PII]. She didn't give me a specific claim number.
[AGENT][POSITIVE] OK, you can send her over and I'll be able to assist you. You have a good day, [PII].
[CUSTOMER][POSITIVE] You too, hon. Thank you.
[AGENT][POSITIVE] Thank you. Goodbye.
[AGENT][NEUTRAL] Hello, how are you doing?
[CUSTOMER][POSITIVE] I'm good.
[AGENT][NEUTRAL] My name is [PII] and I'll be assisting you today. What is the date of service that you're inquiring claim status for?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] I gotta go.
[AGENT][NEUTRAL] [PII]. Do you have a procedure code?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, hold on.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] It is um.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] 99232
[AGENT][POSITIVE] Thank you. For $179.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Say that again please, [PII].
[AGENT][NEUTRAL] Are you, that's for $179?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, so it looks like the originally, originally we requested the EOB to be sent in.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then it looked like.
[CUSTOMER][NEUTRAL] Did they ever get it?
[AGENT][NEUTRAL] Um, it looked like you got you guys did send the ELB in 3234, let me see 3234.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we received that in September back in [PII] it was processed [PII] and it looks like the primary made um.
[AGENT][NEUTRAL] Was it multiple procedure codes? Is it two procedure codes for 99232 and 99239?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So it looks like the primary made a payment. Let me see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I look like the primary didn't make a payment, so let me look at the EOB. Let me pull up the EOB, be patient with me.
[AGENT][NEUTRAL] Oh
[CUSTOMER][POSITIVE] No problem, thank you.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Let me give you that claim number while I'm waiting on the system to come up. It's 3. Let me know when you're ready for it.
[CUSTOMER][POSITIVE] Ready.
[AGENT][NEUTRAL] It's 3503234. And what was your name?
[CUSTOMER][NEUTRAL] Uh 35033324.
[AGENT][NEUTRAL] It's 35, it's 3503234.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you [PII]. So it looks like the primary didn't make a payment on it, so with this gap insurance, how it works is if the primary put put something towards your deductible copay or co-insurance, that's when your policy this policy actually come into effect. But if the primary does not make a payment on it, then that means that we won't make a payment but it looks like they're requesting information from you guys. It says claims services lack information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And has submission billing errors, so looks like you guys need to resubmit this back to the primary.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] OK. I um
[CUSTOMER][NEUTRAL] I don't know what they did with this claim look at it.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] I'm not sure what's missing. Let me look at it and see because I'm not an expert with another insurance company. I know how we process claims, but um.
[CUSTOMER][POSITIVE] No, it's OK. I'll give them a call, yeah.
[CUSTOMER][NEUTRAL] Cause it just looks like it's not a covered benefit with them. I don't know.
[AGENT][NEUTRAL] But it's an inpatient. It's inpatient though.
[CUSTOMER][NEUTRAL] They got both of y'all in the miscellane.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm gonna call them and see what they're saying.
[AGENT][NEUTRAL] So that's.
[AGENT][NEGATIVE] Cause that's why I don't understand why I won't be covered as inpatient.
[CUSTOMER][NEUTRAL] I'm gonna call them and see what's going on with it. How do you spell your name, [PII]?
[AGENT][NEGATIVE] [PII], and today's date as a reference, and then it may not be because it's not covered, but um because you know how insurance company as soon as they see a second insurance, they just don't wanna pay until you prove that they're the primary and the the other one is the secondary, that may be the issue because I don't see why this wouldn't be covered. This is a sickness because it means she had an obstruction or something.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Yeah, I'm gonna, um, a call I don't.
[CUSTOMER][NEUTRAL] I'm gonna give him a call and see what's going on cause I think this claim I looked at this claim about 10 times.
[CUSTOMER][POSITIVE] OK, well thank you so much for taking a look at it.
[AGENT][NEUTRAL] Is there anything else that I can assist you assist with you today?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] No ma'am, thank you so much for your help.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL and have a great day.
[CUSTOMER][POSITIVE] You too thanks bye.