AccountId: 011433970860
ContactId: 3fed7cb3-8996-4125-8c8d-2a1a94b96026
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409760 ms
Total Talk Time (AGENT): 130102 ms
Total Talk Time (CUSTOMER): 148918 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/3fed7cb3-8996-4125-8c8d-2a1a94b96026_20250522T14:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, hi [PII], my name is [PII] calling from products office to check on our claims.
[AGENT][NEUTRAL] OK, I can check on a claim for you. You said your name was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, uh, can I get a good callback number from you? It's [PII]
[CUSTOMER][NEUTRAL] And your names.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][POSITIVE] Thank you so much. Yeah, my good contact number will be [PII] direct line.
[AGENT][NEUTRAL] Thank you. And do you have that policy number?
[CUSTOMER][NEUTRAL] Yup, sure. 024.
[CUSTOMER][NEUTRAL] 33
[CUSTOMER][NEUTRAL] 267.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] I'm sorry, uh, [PII], I think I might have misheard that policy number. Could you repeat that for me?
[CUSTOMER][NEUTRAL] 02433267.
[AGENT][NEUTRAL] OK, I apologize one moment.
[CUSTOMER][NEUTRAL] Yeah no it is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] There we are and thank you for that verifying that information. um, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] And the date of [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 360
[CUSTOMER][NEUTRAL] Yes, $364.87.
[AGENT][POSITIVE] OK, got it. Thank you. One moment.
[CUSTOMER][NEUTRAL] And this one we have a specific question, yeah.
[AGENT][NEUTRAL] Oh yeah, oh, OK, um, do you happen to have that claim number by chance?
[CUSTOMER][NEUTRAL] Yeah, I already have a claim number for you actually sent the primary U be through fax on [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Claim got denied the claim ID will be 359-7636.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it does look like uh we were unable to pay that benefit as office visits are not covered under this policy. There were also several items uh that we were unable to pay a benefit as the insured's primary provided full benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And then it also looks like there.
[CUSTOMER][NEUTRAL] OK. May I know what type of patient plan?
[AGENT][NEUTRAL] Uh, this is a, uh, yeah, this is a secondary medical policy.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Secondary medical policy, patient plan type?
[AGENT][NEUTRAL] Yeah, secondary medical.
[CUSTOMER][NEUTRAL] Did you have a plan name?
[AGENT][NEUTRAL] Uh medlink M E D L I N K.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It will cover uh deductible, primary insurance deductible.
[AGENT][NEUTRAL] It is designed to help with co-pay, deductible and co-insurance after major medical pays. However, this policy does not provide benefits for office visits.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, for office visit, I understand, but you go for deductible, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It is supposed to help with co-pay, deductible and co-insurance, correct?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um yeah, we sent the primary U be on [PII]. Could you please check that for me?
[AGENT][NEUTRAL] Um, I'm not showing that this claim needs a primary EOB. It's simply saying that office visits are not covered.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, for the rest of the CBD?
[CUSTOMER][NEUTRAL] 82947 and 36.
[AGENT][NEUTRAL] That was
[AGENT][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] For line to procedure 82947 and 36416.
[AGENT][NEUTRAL] Yes, according to the information that I have the insured's primary provided full benefits for those, so we were unable to pay anything additional.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So this claim belongs to member responsibility.
[AGENT][NEUTRAL] We don't say what is patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] So it's not a patient responsibility. It's belong to a provider, right?
[AGENT][NEUTRAL] Um, it's up to the provider what is patient responsibility.
[CUSTOMER][NEUTRAL] I, I
[CUSTOMER][NEUTRAL] What can I do for now actually sent already primary UB for this, but after review UB or said benefits are not payable right.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Major medical policy.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Also it's not a patient responsibility, right?
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] Yeah, actually, the primary insurance for the process 36416 process is $9.50 deductible.
[AGENT][NEUTRAL] No, we would need that corrected information. The information that we have doesn't show that there's any, um, that they paid those benefits on those two codes.
[CUSTOMER][NEUTRAL] That we would need
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. For the deductible information you don't have on file, right?
[AGENT][NEUTRAL] For those two particular codes it is stating that insured's primary provided full benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK, I'll resubmit the primary OB.
[CUSTOMER][NEUTRAL] To facts
[AGENT][NEUTRAL] Yes, if that information is incorrect, yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, thank you so much.
[CUSTOMER][POSITIVE] Uh, have a nice day.
[AGENT][NEUTRAL] Oh, is there anything else I could help you with?
[CUSTOMER][NEUTRAL] Let
[CUSTOMER][NEUTRAL] Oh, that's all for now. Bye.
[AGENT][POSITIVE] OK, well thanks for giving us a call have a great rest of your day.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah, bye for now.
[AGENT][NEUTRAL] Bye bye.