AccountId: 011433970860
ContactId: 2f871053-2708-4ba6-8738-03ea22460c34
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259238 ms
Total Talk Time (AGENT): 65891 ms
Total Talk Time (CUSTOMER): 168297 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/2f871053-2708-4ba6-8738-03ea22460c34_20250611T17:11_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII]. My name is [PII] and I'm calling from provider's office. Uh, [PII], actually, I have two claims for a member on which we have received the denial of a non-covered. So I just want to know why it's denied as non-covered means why it is non-covered.
[AGENT][NEUTRAL] OK, I can take a look at it. Could I get a callback number for you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, it's going to be [PII].
[CUSTOMER][NEUTRAL] And [PII], I wanna inform you that the call is being recorded. Yeah, but that, uh, the call is being recorded for internal training and quality purpose.
[AGENT][NEUTRAL] Thank you. The policy number?
[CUSTOMER][NEUTRAL] And the policy number for the member is going to be 202,493,550.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, and you're calling uh for denied claims. Do you have the first, uh, claim number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, I do have that with me, um, yeah.
[CUSTOMER][NEUTRAL] The claim number is going to be 3583.
[CUSTOMER][NEUTRAL] 973.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is for data servers, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, for $138.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. The policy does not cover physician visits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Policy not covers physician billing.
[AGENT][NEUTRAL] Physician visit.
[CUSTOMER][NEUTRAL] Physician visit.
[CUSTOMER][NEUTRAL] OK, it's an outpatient visit. OK, and, uh, you guys are primary for this for this member or members have any you are secondary.
[AGENT][NEUTRAL] No, we are secondary.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] No problem. Uh, do you have the primary payer details with you?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Who is the primary for him?
[CUSTOMER][NEUTRAL] Um, do you have primary insurance detail? I mean, who is the primary for this number?
[AGENT][NEUTRAL] The primary is Blue Cross Blue Shield.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Blue Cross Blue Shield. And can I have the Blue Cross Blue Shield eligibility, I mean, effective and term date.
[AGENT][NEUTRAL] I don't have that information, sir. You would have to verify that with the member.
[CUSTOMER][NEUTRAL] OK. Do you have that?
[CUSTOMER][POSITIVE] OK, no problem. Do you have that information like, uh, that BCBS was active for data service or not? OK, no problem with that. Thank you so much. And I have one more claim for this number only and
[AGENT][NEUTRAL] I do not.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, date of services, uh, date of service or, uh, you want the claim number directly? Yeah, it is 3587409.
[AGENT][NEUTRAL] The claim number.
[AGENT][NEUTRAL] OK, and this is for data service [PII] for $3,098?
[CUSTOMER][NEUTRAL] It's just
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I show this claim we requested the explanation of benefits, the primary explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, no problem. So actually we have built this to you guys as a primary. So I will just go ahead and build this claim to BCBS as a primary now.
[AGENT][NEUTRAL] OK, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah and.
[CUSTOMER][NEUTRAL] Yes, the spelling of your name.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, thank you so much and can I have the call reference number for this call?
[AGENT][NEUTRAL] To reference the call, you'll use my name in today's date.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome. You have a wonderful day.
[CUSTOMER][NEUTRAL] OK sure, how do you, yeah, you too, bye-bye.
[AGENT][NEUTRAL] Bye bye.