AccountId: 011433970860
ContactId: 2ae9aee7-5c8d-4519-86d2-5e03b0396a40
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 343549 ms
Total Talk Time (AGENT): 131327 ms
Total Talk Time (CUSTOMER): 137644 ms
Interruptions: 2
Overall Sentiment: AGENT=2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/2ae9aee7-5c8d-4519-86d2-5e03b0396a40_20250224T17:28_UTC.wav
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[CUSTOMER][NEUTRAL] Hm.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], good morning. I'm [PII] from Yale Medicine. How are you?
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][POSITIVE] That's good. I am well, thank you. I am calling for a claim status today.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, and you said your name is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII], may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Sure, it's [PII] and that number is 02315594.
[AGENT][NEUTRAL] 02315594.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [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 and the total bills for the claim?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Data Services [PII] bill $350.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so once I received the claim twice, um, hold on one moment, which one is the original?
[AGENT][NEUTRAL] OK, so you originally received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3463604.
[CUSTOMER][NEUTRAL] 346-3604
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK, let me see if there's another insurance. Uh, one second.
[CUSTOMER][NEUTRAL] Other insurance.
[CUSTOMER][NEUTRAL] Oh, they have Blue Cross that denied the claim to, let me see.
[CUSTOMER][NEUTRAL] Oh, they're saying they're not primary either.
[CUSTOMER][NEUTRAL] No secondary payment without primary payer information.
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][NEUTRAL] So, so both insurance the same, the same thing.
[AGENT][NEUTRAL] So this, this policy is 2nd to United Healthcare.
[CUSTOMER][NEUTRAL] Secondary to United Healthcare.
[AGENT][NEUTRAL] Yes, our, our Meli policy is secondary only to the UnitedHealthcare policy.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] So that means you have to have a United Healthcare policy then.
[AGENT][NEUTRAL] Yes, that's our major insurance. Well, you know what, hold on.
[CUSTOMER][NEUTRAL] In order to have this insurance.
[AGENT][NEUTRAL] OK, because this, the, the policy that she has with us now is no longer active as of [PII], but when the policy was active, it was second only to UnitedHealthcare.
[CUSTOMER][NEUTRAL] 9124. Let me see what my date was just my date, the date was May, so it was while it was active. So just for clarity, right, with this policy, her primary must be a United Healthcare policy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, this is a
[CUSTOMER][NEUTRAL] Because I'm only showing her with this and Blue Cross Blue Shield, so it have to be a United Healthcare policy.
[AGENT][NEUTRAL] Right, so she has another policy, um, she has a policy with United Healthcare or had, she may have Blue Cross now, but at the time it was United Healthcare.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Yeah, so we got a contact member regarding that policy because we don't have that here.
[AGENT][NEUTRAL] Yeah, and it looks like the, the claim was submitted again to us, but it, um, same type of thing. The explanation of benefits was given, but the, because major didn't apply, we couldn't apply. But if you all file with major and get a decision, you can still uh resubmit to us. There's no timely filing.
[CUSTOMER][NEUTRAL] I'm not seen.
[CUSTOMER][NEUTRAL] What is major?
[AGENT][NEUTRAL] UnitedHealthcare.
[CUSTOMER][NEUTRAL] The United Healthcare? Oh, OK.
[CUSTOMER][NEUTRAL] OK, I'll document this.
[CUSTOMER][NEUTRAL] But her policy term 912024.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, we only have the Blue Cross. I don't see anything in here for United Healthcare. Alright, so I'll reach out to the member and do I need a call reference number, [PII]?
[AGENT][NEUTRAL] Um, there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK. All right, thank you so much.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um, no, this is it.
[AGENT][POSITIVE] Alright, well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.