AccountId: 011433970860
ContactId: 2a4073eb-ad95-4fdd-99aa-9452ae507c96
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 690320 ms
Total Talk Time (AGENT): 186956 ms
Total Talk Time (CUSTOMER): 164205 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/2025/01/13/2a4073eb-ad95-4fdd-99aa-9452ae507c96_20250113T17:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check the general claim status.
[AGENT][POSITIVE] OK, [PII], I'm happy to.
[CUSTOMER][NEUTRAL] And I'm sorry, I missed your name.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII]. OK. Thank you so much, [PII].
[AGENT][NEUTRAL] May I have the policy number, please?
[CUSTOMER][NEUTRAL] Uh, yes, and the policy number will be 02496781.
[AGENT][POSITIVE] Thank you, [PII]. And do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, and the callback number will be [PII].
[AGENT][NEUTRAL] Thank you. And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], and date of birth, [PII].
[AGENT][POSITIVE] Thank you for that date of service.
[CUSTOMER][NEUTRAL] And the date of service will be [PII]. And the bill amount will be $490 even.
[AGENT][NEUTRAL] Right, so it looks like we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, the claim was denied. Benefits are only payable if major medical pays. We are the secondary insurance.
[CUSTOMER][NEUTRAL] Uh, when it was denied?
[AGENT][NEUTRAL] It denied on [PII].
[CUSTOMER][NEUTRAL] OK. And the night before?
[AGENT][NEUTRAL] Benefits are only payable if major medical pays.
[CUSTOMER][NEUTRAL] Benefits
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Payable
[CUSTOMER][NEUTRAL] For medical.
[CUSTOMER][NEUTRAL] Benefits are available for medical.
[AGENT][NEGATIVE] The claim was only payable. The claim was only payable if major medical paid. Their major medical did not pay anything, therefore, there was nothing for us to pay on this.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Just give me a moment.
[CUSTOMER][NEUTRAL] And what uh benefits have been associated?
[AGENT][NEUTRAL] I'm sorry, what was that question again?
[CUSTOMER][NEUTRAL] What was the benefit is this data?
[AGENT][NEUTRAL] We don't have that information on file for their major medical. You would have to contact the insured.
[CUSTOMER][NEUTRAL] OK. Can you please send this claim back for the process?
[AGENT][NEUTRAL] There's nothing to reprocess on the claim. The claim itself was denied because the insured's major medical didn't pay anything, so there was nothing for us to process.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] Then claim is billed with $0.
[AGENT][POSITIVE] It was denied, correct.
[CUSTOMER][NEUTRAL] Just give me a
[CUSTOMER][NEUTRAL] Then you're saying for this plan, the bill amount is $0. Is that right?
[AGENT][NEUTRAL] I'm saying that there was nothing paid on the claim.
[CUSTOMER][NEUTRAL] There's nothing paid on the claim.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Can you please give me the denial reason again?
[AGENT][NEUTRAL] Benefits are only payable if major medical insurance provides benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What just happened?
[CUSTOMER][NEUTRAL] What does it mean? Sorry.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] What does it mean?
[AGENT][NEUTRAL] That we're only gonna pay on the claim if the insured's major medical.
[AGENT][NEUTRAL] Pays on the claim.
[AGENT][NEGATIVE] So no benefits were provided by the insured's major medical. Therefore, we paid nothing because we are the secondary insurance.
[CUSTOMER][NEUTRAL] And who is the major medical?
[AGENT][NEUTRAL] We do not have that information on file. You need to contact the insured.
[CUSTOMER][NEUTRAL] OK. And when was this uh COP last updated for this patient?
[AGENT][NEUTRAL] Uh, the
[AGENT][NEUTRAL] Claim was processed on the [PII].
[CUSTOMER][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] OK. Can you please help me with the COVID information?
[CUSTOMER][NEUTRAL] Coordination of benefits information.
[AGENT][NEUTRAL] There's no coordination of benefits.
[CUSTOMER][NEUTRAL] There is no information. OK. When it was last updated?
[AGENT][NEUTRAL] When was what last updated?
[CUSTOMER][NEUTRAL] Coordination of benefits when it was last updated.
[AGENT][NEUTRAL] There
[AGENT][NEGATIVE] There is no coordination of benefits.
[AGENT][NEGATIVE] So there is no update.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK. Can you know when to when the Aetna is secondary?
[AGENT][NEUTRAL] For the secondary insurance.
[CUSTOMER][NEUTRAL] Yes, from, effective from 1 to 1.
[AGENT][NEUTRAL] The effective date on this policy is [PII]. The patient is still active.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. There is any letter has been sent to a patient?
[AGENT][NEUTRAL] And EOB would have been sent out to the patient, yes.
[CUSTOMER][NEUTRAL] UOP has been sent to patient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can I get the color reference number for this one?
[AGENT][NEUTRAL] Call reference would be my name with my last initial than today's date. My name again is [PII], last initial is [PII].
[CUSTOMER][NEUTRAL] OK, sir. I have one other patient. Can you please help me with that?
[AGENT][NEUTRAL] Let me finish noting this and I can check the next 11 moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I'm ready for the next policy number when you are.
[CUSTOMER][NEUTRAL] Yes, and the policy number will be 1,067,610.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] And the patient's name will be [PII] and it was [PII].
[AGENT][POSITIVE] Thank you, data service.
[CUSTOMER][NEUTRAL] And the date of service will be [PII].
[CUSTOMER][NEUTRAL] And bill amount will be $34.
[AGENT][POSITIVE] Thank you for that. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, so it looks like we did receive the claim on [PII]. Uh, the claim was denied. Services were rendered after the coverage was effective.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was, when was the what was active and terminated?
[AGENT][NEUTRAL] Effective date is [PII]. The termination date was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And there is no other insurance active for this patient.
[AGENT][NEUTRAL] Correct, there's other active coverage.
[CUSTOMER][NEUTRAL] OK. Just give me a moment.
[CUSTOMER][NEUTRAL] One moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK. Thank you so much for that information. And can I get the call reference number?
[AGENT][NEUTRAL] Call reference my name with my last initial and today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I can check for you?
[CUSTOMER][POSITIVE] No, thank you so much. Have a wonderful day. Take care. You too. Bye-bye.
[AGENT][NEUTRAL] You too. Bye-bye.