AccountId: 011433970860
ContactId: 4fcdb45c-56b0-40ed-aaa3-c12f9ce6e198
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 279959 ms
Total Talk Time (AGENT): 107755 ms
Total Talk Time (CUSTOMER): 115063 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/4fcdb45c-56b0-40ed-aaa3-c12f9ce6e198_20250203T18:24_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I need to discuss a claim.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, are you needing claim status, [PII], or do you already have the claim number?
[AGENT][NEUTRAL] And you have a question on it. Yes, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] I have the claim number.
[CUSTOMER][NEUTRAL] [PII]. No extension.
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] 02036914 M as in Mike, L as in Lima, number 8.
[AGENT][POSITIVE] OK, thank you. Give me just a couple of moments for you, [PII] to get all of the member's information pulled up so I can help you with this.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] My name is [PII] I.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And [PII], if you're gonna need the first initials of my last name, it's [PII].
[CUSTOMER][NEUTRAL] And your first name is [PII], [PII], right?
[AGENT][NEUTRAL] Actually, I spell it with an [PII] instead of [PII]
[CUSTOMER][NEUTRAL] OK. [PII]
[AGENT][NEUTRAL] OK, and any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is
[CUSTOMER][NEUTRAL] Uh, [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] [PII] $3060 even.
[AGENT][NEUTRAL] 3060. Is that correct?
[CUSTOMER][POSITIVE] Yes, yes. I have the claim number, OK. Thank you.
[AGENT][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] And what is the claim number that you have?
[CUSTOMER][NEUTRAL] She did.
[CUSTOMER][NEUTRAL] Yes, claim number 353-9242.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Correct
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] $3.
[AGENT][NEUTRAL] OK, so yes, sir. um how can I help you with that?
[CUSTOMER][NEUTRAL] So, I'm looking, we issued a letter like explanation of benefits. And it looks like this claim got denied that please provide copies of your explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] So, actually, uh, I'm looking that there is no other insurance on file. So this claim should be processed as a primary because
[AGENT][NEUTRAL] No, sir. It should not be. We are not a major, no, sir. That is not correct. We are not a major medical insurance carrier. This is only a supplemental policy to their primary healthcare insurance.
[CUSTOMER][NEUTRAL] And my, yeah.
[AGENT][NEUTRAL] This
[CUSTOMER][NEUTRAL] Oh, so you are the supplemental.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] One minute supplement. So can you check that and um who is the primary in your record?
[AGENT][NEUTRAL] I can tell you who we show for that employer, but you would have to contact the member to get any detailed information on their major medical coverage. We show that it's Aetna AFA.
[CUSTOMER][NEUTRAL] Yes, Aetna. Yeah, uh, it's showing Aetna is the primary, uh, but we have checked the eligibility of Aetna on ability and it's showing it's a secondary, also secondary carrier.
[AGENT][NEUTRAL] OK. According to our records, this is the member, this would have been the member's primary insurance. Again, you would have to reach out to the member.
[CUSTOMER][NEUTRAL] OK, thank you. What's, uh, OK. What's the reference number, please?
[AGENT][NEUTRAL] Uh, it would be my name along with today's date.
[CUSTOMER][POSITIVE] OK, got it. Thank you so much for you, stay safe.
[AGENT][POSITIVE] OK. Well, you're very welcome and thank you again for calling APLJ if that's all I can help you with, and I hope you have a nice afternoon also.
[CUSTOMER][POSITIVE] Sure, thank you. Bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.