AccountId: 011433970860
ContactId: 4e60057a-7e1c-4587-bd27-0a69091dc606
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 327920 ms
Total Talk Time (AGENT): 171577 ms
Total Talk Time (CUSTOMER): 92665 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/4e60057a-7e1c-4587-bd27-0a69091dc606_20250509T22:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi, [PII], my name is [PII] and I just wanted to understand, um, the description that of explanation of benefits because some mm something wasn't covered.
[CUSTOMER][NEUTRAL] And I just wanted to understand why.
[AGENT][NEUTRAL] Sure, OK, so we're just needing clarification regarding a claim denial.
[CUSTOMER][NEGATIVE] I think it was an L, yeah, denied.
[AGENT][NEUTRAL] OK, I can definitely check that for you. uh, Will, is this for your individual policy or are you with a provider?
[CUSTOMER][NEUTRAL] Uh, yeah, it's from
[CUSTOMER][NEUTRAL] I'm sorry, I don't understand the question. It's for me specifically.
[AGENT][NEUTRAL] It is for you, OK. I just wanted to make sure that it was yours. Um, can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then do you have your policy number?
[CUSTOMER][NEUTRAL] Policy number, yes, it is uh 262-064-1.
[AGENT][NEUTRAL] OK, and what was your last name, [PII]?
[CUSTOMER][NEUTRAL] Last name is uh [PII].
[AGENT][NEUTRAL] OK, I'm just gonna verify some information really quick. Uh, can I get your date of birth please?
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] Mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK and then uh last thing I need is the email address we've got on file for you. It looks like it is a Gmail account.
[CUSTOMER][NEUTRAL] 333 0 the email uh [PII].
[AGENT][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Perfect thank you for verifying all of that. OK um let's see it looks like we got a couple of claims uh from you uh do you have that claim number that we're looking at?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, um,
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Actually I'm a little confused because it looks I have like it looks like I I might have made a mistake and submitted this submitted the same.
[CUSTOMER][NEUTRAL] Bill for the 2, the two claims.
[AGENT][NEUTRAL] Oh, OK. I could just take a look at both of them. Give me just a moment.
[AGENT][NEUTRAL] OK, so for the first claim that we received.
[AGENT][NEUTRAL] It looks like the first item we were unable to pay that benefit as office visits are not covered under this policy for all of the other items we're missing a copy of the primary EOB so as this is a secondary medical policy, uh, we do have to have that information showing what your primary insurance paid before this policy is able to.
[AGENT][NEUTRAL] And you can get that from the provider uh wherever you went for treatment, they'll have that information.
[CUSTOMER][NEUTRAL] What what do I need to ask him for?
[AGENT][NEUTRAL] The primary EOB from the uh date of service.
[CUSTOMER][NEUTRAL] The EOB.
[AGENT][NEUTRAL] Yes, explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] Can I just provide that with you guys by going into my.
[CUSTOMER][NEUTRAL] Into my site and then submitting that to you?
[AGENT][POSITIVE] Yeah, you can get it that to us through our website absolutely.
[AGENT][NEUTRAL] At this other, uh, claim that you, I'm sorry.
[CUSTOMER][NEUTRAL] So how would I, uh, I would, I would just I would just I would just upload the file.
[AGENT][POSITIVE] Yes absolutely um and now you know if they ideally they'll send it out to you electronically like maybe as a PDF or something that way you can just simply upload it that way uh if they do give you a physical copy you know of course you're more than welcome to scan it or you know you could also just take a picture of them and upload them that way as well as long as it's clear and legible that's perfectly fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So this other claim that you submitted, um, I'm not showing anything is registered as a duplicate so it does appear to be uh different claim information but as for all of this as well we are missing the primary EOB so I'm showing this one is from.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cora Physical therapy and the other one, give me just a moment, I was just there.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh, let's see.
[AGENT][NEUTRAL] Is it, uh, [PII]? I is it [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Yes, yes, so those, right, so for, um, [PII] or excuse me, [PII] and then [PII]. So if you would just go to, uh, give both of those providers a call and explain that you need the primary explanation of benefits, uh, you could just upload that as soon as you get it and then we can continue processing these claims.
[CUSTOMER][NEUTRAL] [PII], yeah.
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][NEUTRAL] Of course is there anything else I can help you with?
[CUSTOMER][POSITIVE] That's all thanks.
[AGENT][POSITIVE] Alright, yep, thanks for calling APL have a great rest of your day.
[CUSTOMER][NEUTRAL] OK, you too, bye bye.
[AGENT][POSITIVE] Thanks. Bye-bye.