AccountId: 011433970860
ContactId: 426540a7-8cb0-4fe0-ad58-3a0792e77e8c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 430160 ms
Total Talk Time (AGENT): 217650 ms
Total Talk Time (CUSTOMER): 178463 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/426540a7-8cb0-4fe0-ad58-3a0792e77e8c_20250321T20:37_UTC.wav
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[AGENT][POSITIVE] Afternoon thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm just calling to inquire about an invoice I received um for a uh medical procedure and um so I called them to inquire about the balance and they said that they processed my primary insurance and then they tried to process with APL but they didn't receive a statement of benefits or something um and so I was gonna call to inquire about that.
[AGENT][NEUTRAL] I can help you with that. Do you have your policy number available?
[CUSTOMER][NEUTRAL] I do, um, it's 02475815.
[AGENT][POSITIVE] Thank you and what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you mind verifying your name and date of birth?
[CUSTOMER][NEUTRAL] Yep, it's [PII] and that's [PII].
[AGENT][NEUTRAL] Thank you. And current mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, thank you, and you know what, while I got you on the line I do have an email on file. Can we go ahead and verify that? I know there's a lot of verification.
[CUSTOMER][NEUTRAL] It's OK. Um, I have two emails. I don't know if you have my work one or my personal, so does it start with an [PII]?
[AGENT][NEUTRAL] [PII] or [PII] the [PII] [PII]
[CUSTOMER][NEUTRAL] OK, so then
[CUSTOMER][NEUTRAL] OK, yeah, so then it would be [PII].
[AGENT][NEUTRAL] That's what we have on file. Thank you for that verification and let me ask you on that invoice, does it give a date of service or do you remember what date the services were provided?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, yeah, let me look. It says
[CUSTOMER][NEUTRAL] Date of service.
[CUSTOMER][NEUTRAL] Um, there's two of them here. One of them is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check that one real quick.
[CUSTOMER][NEUTRAL] And then the sec
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] So we did receive a claim from Bonsecur's Hospital, Saint Mary's Hospital.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For a billed amount of $1,194 is that the claim you're referring to?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And we did receive that claim.
[AGENT][NEUTRAL] On [PII] and processed on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], when they sent the claim to us, they did not send your primary explanation of benefits with the claim.
[AGENT][NEUTRAL] And because we are secondary, we always have to have that primary EOB with the claim submitted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We did send them a letter on [PII] to them requesting that they send in that primary EOB.
[AGENT][NEGATIVE] And we've not received it yet.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] You should have received one to your to your home as well.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Given that decision.
[CUSTOMER][NEUTRAL] I probably did. Yeah, I probably did.
[AGENT][NEUTRAL] So that's what, it's not that it's denied or anything, it's just pending for your primary insurance for that claim information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so do you think that if like would it help if I called them to inquire about it?
[AGENT][NEUTRAL] You can and just tell them that you called us to check the claim information and I can give you a claim that I can give you anything you need to and tell them that we sent them a request for the primary EOB.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And that would probably help.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That would probably do better than even me trying to call him.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, all right, yeah, let me, let me try and do that.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And I can give you a claim number if you need that as well.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] The claim number is 35561.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 27.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, well, that's helpful, at least we're getting somewhere.
[AGENT][NEUTRAL] And you can
[AGENT][NEUTRAL] Yeah, and you can even pull it up online if you go. I see you have an active portal account under my claims you can click on that claim number and view the our.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Explanation of benefits and what we sent them.
[CUSTOMER][NEUTRAL] Right, OK.
[AGENT][NEUTRAL] So that was for [PII]. You said you had two dates of service. What's the next date of service?
[CUSTOMER][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] The next one is [PII], but I have a feeling that that 1 may be a copay.
[AGENT][NEUTRAL] For a doctor's office?
[CUSTOMER][NEUTRAL] But yeah, I mean, you can, yeah, probably, but I'm not sure so we might as well just check it.
[AGENT][NEUTRAL] Sure. And that looks like an office visit, which is not covered under your plan.
[CUSTOMER][NEUTRAL] Right, yeah.
[CUSTOMER][NEUTRAL] Right. That's what I thought. Yeah, that's the 2nd, you know, that's the, um, that was like the
[CUSTOMER][NEUTRAL] The doctor's office visit after the actual um scan that I had. So yeah, that makes sense.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that one's not covered, but the one for the um.
[AGENT][NEUTRAL] [PII] we need to get that primary EOB on file so we can continue processing the claim.
[CUSTOMER][NEUTRAL] Right, got you, OK, let me try giving them a call and see how far I get.
[AGENT][NEUTRAL] Yes ma'am, if they wanna call us, we'll be happy to verify that we do need that primary EOB if you get someone, ask them if they can fax it to us.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And I can give you a fax number because the quicker we get it, the better off you are.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, is it the, um, is it the [PII]?
[AGENT][NEUTRAL] That it that comes straight to our claims department that's correct.
[CUSTOMER][POSITIVE] Perfect, OK.
[CUSTOMER][POSITIVE] All right, I am gonna do exactly that. I'm gonna call them, I'm gonna ask them, and then I'm gonna see if they'll fax it to you.
[AGENT][NEGATIVE] And then say, look, you know, do your job. No, I'm just kidding, don't say that.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah, no, no, yeah, no, you get, I think you get farther with honey than whatever vinegar, whatever that saying is.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's right. That's right. That's right. But it is, it's not denied, it's just pending for that primary EOB.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK. All right, well, let me see what I can do here. Thank you so much for your time.
[AGENT][POSITIVE] Oh, it's been such a pleasure to assist you, Miss [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Nope, that's it.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a lovely weekend let us know if we can be of further assistance.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] OK, bye.