AccountId: 011433970860
ContactId: 3010799a-74bb-49f6-bbf2-22c20cd7dfdd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 271839 ms
Total Talk Time (AGENT): 106872 ms
Total Talk Time (CUSTOMER): 96551 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/3010799a-74bb-49f6-bbf2-22c20cd7dfdd_20250402T15:31_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm with Miami VA Medical Center and I need a claim status, please.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim status, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the policy number is 01611887 M as in Mary, L as in Lima 8.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] I'm gonna spell this first name because I have no clue how to say this. [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] Thank you, and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] [PII] for $903.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] So it looks like we received this twice. Um, the original claim was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim number is 354.
[AGENT][NEUTRAL] 4355.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So my question is, are you guys only secondary insurance?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, because the patient's primary canceled [PII].
[AGENT][NEUTRAL] You know Healthcare?
[CUSTOMER][NEGATIVE] And he didn't get new insurance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So we, uh, no, uh uh.
[AGENT][NEUTRAL] So this policy is 2nd.
[CUSTOMER][NEUTRAL] When, when do you guys show that his
[AGENT][NEUTRAL] So this meddling policy is 2, go ahead.
[CUSTOMER][NEUTRAL] Because we
[CUSTOMER][NEUTRAL] So it's, it's secondary. I see, I see that, but like we had that, he didn't get United Healthcare until [PII].
[AGENT][NEUTRAL] Hold on one second.
[CUSTOMER][NEUTRAL] So she.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] So, this policy has been active with APL since [PII] and this policy is second only to United Healthcare. So I don't know what happened on the United Healthcare side. We haven't from how it shows on our side that
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] They've only had UnitedHealthcare, but
[AGENT][NEUTRAL] They've had it since October. We're only 2nd to them.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, only secondary to UHC.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] Can you give me the other claims, um, claim number since we never received an EOB for the other one, just so I can have it.
[AGENT][NEUTRAL] The duplicate, oh, sure, hold on one second.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so that claim number is 354.
[AGENT][NEUTRAL] 9074.
[AGENT][NEGATIVE] We received it on [PII] and it was denied as a duplicate on [PII].
[CUSTOMER][POSITIVE] OK. All right. This is all good information that I need.
[AGENT][POSITIVE] Alrighty, well, thank you so much for calling APL [PII]. I hope you have a great day.
[CUSTOMER][NEUTRAL] Uh, do you guys give reference numbers?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date. Um, the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, thank you so much. Have a great day.
[AGENT][POSITIVE] You also, [PII], thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you. Bye.