AccountId: 011433970860
ContactId: 283e0cb4-3806-41cd-83db-5bd07a2883d0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 202710 ms
Total Talk Time (AGENT): 108416 ms
Total Talk Time (CUSTOMER): 81990 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/283e0cb4-3806-41cd-83db-5bd07a2883d0_20250514T18:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, this is [PII] at Doctor [PII]'s office. I have a question in regards to a claim, please.
[AGENT][NEUTRAL] Yes, I can take a look at that claim for you. Uh, [PII], can I get a good callback number from you first in case we're disconnected?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] [PII], that's correct.
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] I do. It's 022-03919 ML 7.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that. Uh, do you have that claim number, [PII]?
[CUSTOMER][NEUTRAL] Um, I do. 00, maybe I don't, I don't.
[AGENT][NEUTRAL] That's OK. Um, what was the date of service?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The date of service is [PII] for $150.
[AGENT][NEUTRAL] 150. OK, thank you one moment.
[CUSTOMER][NEUTRAL] Oh, actually, you know what? I do have the claim number. Give me a second.
[AGENT][NEUTRAL] Yes. OK, sure.
[CUSTOMER][NEUTRAL] It is 358-631-8.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] OK, so for this claim, [PII], it looks like we're just missing a copy of the primary EOB. So this is their secondary medical policy, uh, so we do need that primary EOB before we can continue uh processing.
[CUSTOMER][NEUTRAL] OK, so you know what, when I send the claim to Cigna, which is the primary, they're asking for the secondary EOB.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, I've never heard of that, um.
[CUSTOMER][NEUTRAL] Um, which I did send to you guys, yeah.
[AGENT][NEUTRAL] Interesting, yeah, so the way that this, I'm not quite sure either, um, all I know is the way that this policy works is it cannot pay or even process until we have the primary EOB um so did Cigna contribute anything to this um procedure or treatment?
[CUSTOMER][NEUTRAL] So I don't know.
[CUSTOMER][NEUTRAL] Um, yes, no, they did not, um, pay anything towards this. They did, um, tell me though that, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] They didn't
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They need the um your EOB.
[AGENT][NEUTRAL] Yeah, I've never heard of that. So in order for this policy, in order for this policy to pay, pri the primary insurance does have to pay first.
[CUSTOMER][NEUTRAL] So now I am like between a rock and a hard place.
[AGENT][NEUTRAL] And we have to have record of that before we can uh process claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so this is, um, so the signa is it this a marketplace plan?
[AGENT][NEUTRAL] No, this, so this is um as American Public Life, this is a supplemental policy um through their employer, and again it is just a secondary medical policy. It can't be used instead of their primary. It helps with a co-pay, deductible and co-insurance after major medical pays.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, OK, OK, very well.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, I will let them know that.
[AGENT][POSITIVE] All right, sorry for the confusion. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Uh, no, that's it, thank you very much.
[AGENT][POSITIVE] Alright, of course, thanks for calling APLO. You have a great rest of your day.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.