AccountId: 011433970860
ContactId: 565f174e-4992-489c-8c6e-ac09cedda1a2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 231559 ms
Total Talk Time (AGENT): 107908 ms
Total Talk Time (CUSTOMER): 92447 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/565f174e-4992-489c-8c6e-ac09cedda1a2_20250113T14:44_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. Last initial is [PII] I'm calling regarding a claim.
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you [PII]. can I get the insurance policy number?
[CUSTOMER][NEUTRAL] Yes, it is 02497688.
[AGENT][NEUTRAL] OK, thank you [PII]. Can you confirm the insured's name and date of birth for me?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, give me just a second.
[AGENT][NEUTRAL] OK, thank you and [PII], you said you're calling to check on a claim, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can definitely take a look. What's that data service and build amount?
[CUSTOMER][NEUTRAL] [PII] for $850.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Let me do some math here for just a second.
[AGENT][NEUTRAL] Have you received any correspondence on this claim?
[CUSTOMER][NEGATIVE] We did, um, we did, and there is a denial on 87635 and 87651 stating another attachment is needed, but it doesn't say what is needed.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] All right. So,
[AGENT][NEUTRAL] Let me give you the claim number. Do you have the claim number?
[CUSTOMER][NEUTRAL] Yes, I have the claim number.
[AGENT][NEUTRAL] OK, so the 99213, it denied as office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But the remainder of the claim, it did deny stating that the primary insurance EOB is needed.
[CUSTOMER][NEUTRAL] So this is a COB issue then really um cause we don't have another insurance listed.
[AGENT][NEUTRAL] OK, yes, this is a Medli secondary uh supplemental policy. So this would be the um secondary insurance for the insured.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Hold on, I'm writing, sorry. You don't.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] You don't have to have his primary do you because we don't have anything at all.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] I'm sorry, I don't, you would actually have to reach out to the policyholder, which is going to be [PII].
[CUSTOMER][NEUTRAL] OK, right.
[CUSTOMER][NEUTRAL] Right, yeah, I'll do that. I was just hoping there was a shortcut, maybe I could find something, but.
[AGENT][POSITIVE] I wish I had that. I know it's Monday and that would make it so much easier for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, but I will reach out. I do see something but I'm not sure if this is it.
[CUSTOMER][NEUTRAL] Maybe I'll call them first. I see a signa, so maybe I'll call them first and see if they still got coverage. OK.
[AGENT][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] Well, do you have a call back now?
[AGENT][NEUTRAL] I do, um, just if I just want to let you know this claim was received on [PII] and it was processed the same day, just kind of wanted to give you that in case you wanted that for your records as well. And the call reference number is gonna be my name [PII] with the first initial to my last name [PII], and today's date.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is there anything else I can take a look at for you?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] No, I think that's all I need. I appreciate it.
[AGENT][POSITIVE] OK, well thanks for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Oh thank you.
[AGENT][NEUTRAL] OK, well, bye bye.