AccountId: 011433970860
ContactId: 45f8af41-5f2d-4570-a1cd-3201958094a1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 643900 ms
Total Talk Time (AGENT): 147368 ms
Total Talk Time (CUSTOMER): 246798 ms
Interruptions: 6
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/45f8af41-5f2d-4570-a1cd-3201958094a1_20250305T21:51_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from provider's office. My last name and initial as [PII].
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] So I need a claim.
[CUSTOMER][NEUTRAL] Yeah, proceed, go on.
[AGENT][POSITIVE] How can I help today, sir?
[CUSTOMER][NEUTRAL] Yeah, I need a claim status. Could you help me with that?
[AGENT][POSITIVE] Happy to help. What's the policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is gonna be.
[CUSTOMER][NEUTRAL] I have the member ID. Can I provide that?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, go ahead.
[CUSTOMER][NEUTRAL] Yeah. 0212025 M as in Mike, L as in Lima, 8.
[AGENT][POSITIVE] Thank you and do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, my callback number is [PII] with the extension of [PII].
[AGENT][NEUTRAL] Thank you. And just to confirm, the policy number was 0212025.
[CUSTOMER][NEUTRAL] M L H.
[CUSTOMER][NEUTRAL] classification.
[AGENT][NEUTRAL] What's the patient's first name and last name?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah. Person's first name is [PII].
[CUSTOMER][NEUTRAL] number 70840712.
[AGENT][NEUTRAL] First name is [PII]. Can you spell the last name?
[CUSTOMER][NEUTRAL] Yeah. First name is [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] 434103.
[AGENT][NEUTRAL] Can you spell the last name?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah. [PII].
[AGENT][NEUTRAL] All right, let me take a look by name because that policy number isn't bringing up anything.
[CUSTOMER][NEGATIVE] didn't have anything.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah. Could you please
[CUSTOMER][NEUTRAL] Take this number.
[CUSTOMER][NEUTRAL] I have said, please verify it.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] What's the number that you have?
[CUSTOMER][NEUTRAL] Yeah, 02.
[CUSTOMER][NEUTRAL] 12
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 5 ML 8.
[CUSTOMER][NEUTRAL] 0160.
[AGENT][NEUTRAL] As previously stated, [PII], that's not a valid policy number. What's the patient's date of birth?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah, based on data about this.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Alright, thank you so much. What's the date of service?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[AGENT][NEUTRAL] Build them out.
[CUSTOMER][NEUTRAL] Yeah, the bill amount is $425 and events.
[AGENT][NEUTRAL] $423.
[CUSTOMER][NEUTRAL] $425 and events.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] Call
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, this information.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, but I don't
[AGENT][NEUTRAL] So the claim was received on [PII].
[CUSTOMER][NEUTRAL] One moment, I didn't ready.
[CUSTOMER][NEUTRAL] Yeah. Now, you can proceed. Go ahead.
[AGENT][NEUTRAL] Claims received on [PII].
[CUSTOMER][NEUTRAL] Received on
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Claim is processed on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Same date, right?
[AGENT][NEGATIVE] Correct, claim was denied.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We need the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] The paper.
[CUSTOMER][NEUTRAL] So which is the primary?
[AGENT][NEUTRAL] We do not have that information. You need to contact the insured.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Insurance. Which insurance?
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] We do not have the primary insurance information. You would need to contact the insured.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Harida?
[AGENT][NEUTRAL] Uh-huh, I'm still here.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm still here.
[CUSTOMER][NEUTRAL] So we have to send an appeal, right?
[AGENT][NEUTRAL] No, all that we need is the explanation of benefits from the primary insurance. That's all that's needed.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Need the primary insurance. We have to send the UOB on the.
[CUSTOMER][NEUTRAL] How do I
[AGENT][NEUTRAL] From the primary because we're the secondary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You are secondary. OK. One moment. Please wait. I, I'll check.
[AGENT][POSITIVE] Correct. OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, the secondary, the primary is the Blue Cross Local, [PII], is it?
[AGENT][NEUTRAL] I don't have that information, sir. You have to check with the insured. We don't have the primary information for the insurance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] In, in here, I have, I have seen that the primary insurance was American Public Life. So therefore I'm asking you.
[AGENT][NEUTRAL] I'm letting you know that we're the secondary, this is their secondary plan. We're not the primary.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] So on.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, sorry for the inconvenience. Yeah.
[CUSTOMER][NEUTRAL] So you didn't know the primary insurance, right?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] You have to take the reprocess this claim.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] This insurance is only going to pay if the primary pays.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, I said you have to take the claim as reprocess.
[AGENT][NEUTRAL] It can be reprocessed once we receive the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is there anything else that I can check on for you today?
[CUSTOMER][NEUTRAL] Yeah, you have to proceed.
[AGENT][NEUTRAL] What other informat[PII]?
[CUSTOMER][NEUTRAL] Yeah, you have to proceed that.
[AGENT][NEUTRAL] What other information did you need from me today?
[CUSTOMER][NEUTRAL] You have to
[CUSTOMER][NEUTRAL] Yeah, you have to take the claims and reprocess, so I need that.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim cannot be reprocessed without an explanation of benefits from the primary insurance and we do not have that.
[CUSTOMER][NEUTRAL] I, I said you are the primary insurance that I have seen here.
[AGENT][NEUTRAL] OK, and I'm advising you that that is not the case. We're not the primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] OK. Thank you for calling.
[AGENT][POSITIVE] You're welcome. Anything else I can help with today?
[CUSTOMER][NEUTRAL] Oh well.
[AGENT][POSITIVE] All right, thank you so much have a good day.
[CUSTOMER][NEUTRAL] Yeah.