AccountId: 011433970860
ContactId: 37dc4f31-ea48-4ed3-8ca5-5757987eae00
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 267589 ms
Total Talk Time (AGENT): 75639 ms
Total Talk Time (CUSTOMER): 90119 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/37dc4f31-ea48-4ed3-8ca5-5757987eae00_20250606T19:03_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], this is [PII] from Baptist Hospital in [PII]. How are you today?
[AGENT][POSITIVE] Good. How are you?
[CUSTOMER][NEUTRAL] Good, thank you. I was just checking. We sent in a claim, a secondary claim for um to Aetna Insurance to you guys. I was wondering if you guys had uh processed it yet, please?
[AGENT][NEUTRAL] OK, and can I get your name one more time?
[CUSTOMER][NEUTRAL] Yeah, [PII]
[AGENT][POSITIVE] and a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, um, [PII].
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] 01678796.
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Yeah, yeah, sure. [PII], [PII].
[AGENT][POSITIVE] OK, thank you so much for verifying that with me.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And when was the date of service?
[CUSTOMER][NEUTRAL] Um, [PII] of this year.
[CUSTOMER][NEUTRAL] And the amount of the claim was 41,354.
[AGENT][NEUTRAL] Alright, let me look.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Give me one moment while I look it up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, it looks like we received that claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] Uh, the claim number is 3602463.
[AGENT][NEUTRAL] And it looks like it was denied due to the benefits payable under the certificate are limited to those outlined on the scheduled benefits. Uh, therefore, this is not a covered loss under the plan, so there's no amount no amount is payable for this expense. It's not a covered service.
[CUSTOMER][NEUTRAL] Not covered service. OK, perfect. All right, and what is the, the effective date of this plan, please?
[AGENT][NEUTRAL] We see.
[AGENT][NEUTRAL] It looks like this plan uh has an effective date of [PII], I'm sorry, [PII].
[CUSTOMER][NEUTRAL] So, let's see.
[CUSTOMER][NEUTRAL] OK. So nothing is covered under the um these codes are not covered under the secondary.
[CUSTOMER][NEUTRAL] OK. I just want to make sure cause they had a big, she has a big balance. Yeah. It's for chemotherapy.
[AGENT][NEUTRAL] Correct. Yeah, not that one.
[CUSTOMER][NEUTRAL] Chemotherapy drugs, so, and it's a big amount that she has left from the primary 6,876, so I just wanted to make sure, you know, cause I have to bill her.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. So it's not covered on her plan. OK.
[CUSTOMER][POSITIVE] OK, great. I appreciate your help today. Have a great day. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for calling APL. I hope you have a great weekend.
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.
[AGENT][NEUTRAL] Right bye.