AccountId: 011433970860
ContactId: 5685fbe0-7917-4f90-9ba1-809e892f7865
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 428630 ms
Total Talk Time (AGENT): 73233 ms
Total Talk Time (CUSTOMER): 174542 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/5685fbe0-7917-4f90-9ba1-809e892f7865_20250217T22:53_UTC.wav
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[AGENT][NEUTRAL] For calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm with West County Radilogy Group. I've got a denial, um.
[CUSTOMER][NEUTRAL] And I'm, I'm trying to understand exactly why no benefits were paid on it um can I give you the claim number or?
[AGENT][POSITIVE] Of course I'd be happy to assist with the claim today. I'm sorry, can you uh repeat your first name for me?
[CUSTOMER][NEUTRAL] [PII] and the initial of my last name is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, and [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Direct dial [PII].
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] The policy number that I have is 018691997, but actually on the paper I have from you all, it says 02006181.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII] or [PII] 5 rather.
[AGENT][NEUTRAL] And what is the date of service for the claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your tax ID.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And I do have a claim number as well if you need that.
[AGENT][NEUTRAL] OK, is that claim number 346-4366?
[CUSTOMER][NEUTRAL] It is indeed.
[AGENT][NEUTRAL] OK, so I'm showing the claim was denied because we need the EOB from the primary insurance since we're their gap insurance.
[CUSTOMER][NEGATIVE] Is there a way to get something that says that's what you need because if I file this to another carrier, which I'm not even sure what other carrier they have, there's a good chance it'll deny is untimely and I and what we got from you doesn't say that's what you need.
[AGENT][NEUTRAL] What denial do you have?
[CUSTOMER][NEGATIVE] It just shows 0 paid.
[CUSTOMER][NEGATIVE] We have a denial.
[CUSTOMER][NEUTRAL] I mean it really doesn't say much on it. It says it's an explanation of benefits at the top and then it, it has all the information check date, extension, policy number, reference number insured and then the second line is claim number, claimant relationship, bill charges but on the body of it it just says provider service West County radiology outpatient expenses procedure 70,450.
[CUSTOMER][NEGATIVE] This product does not have a provider participation network. Benefits have not been reduced. Total benefits paid $0.
[CUSTOMER][NEUTRAL] And that's all I have.
[AGENT][NEGATIVE] There's not a um remark code or number. It should have been 2 pages.
[CUSTOMER][NEGATIVE] I don't have a 2nd page.
[CUSTOMER][NEUTRAL] I only have page one.
[CUSTOMER][NEUTRAL] Um, let me see here.
[CUSTOMER][NEGATIVE] Yeah, I only have a page one. I don't have a second page.
[AGENT][NEUTRAL] OK, and what was that data service again?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And I'm sorry, I didn't write your name down when we first started speaking.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Right, and [PII], may I get the initial to your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Can I get you to fax or email that to me?
[AGENT][NEUTRAL] Yeah, I'm pulling it up now. One moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Yeah, it should have been 2 pages and the second page has the remark remark description is please provide copies of your explanation of benefits from your primary care insurance. So let me get this over to you, one moment.
[AGENT][NEUTRAL] OK, what's that fax number?
[CUSTOMER][NEUTRAL] Uh, you can fax it to me directly at [PII].
[CUSTOMER][NEUTRAL] And then do you know who you were showing uh the the primary insurance was in April of last year?
[AGENT][NEUTRAL] Um, we don't give out that information. You would have to ask the, um, insured for that information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, you should receive that in the next 5 to 7 minutes.
[CUSTOMER][NEUTRAL] Alright, one last question just for documentation purposes, may I get a call reference number for our call today?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call.
[CUSTOMER][POSITIVE] Name and date. OK, alright, thank you, [PII] have a great evening.
[AGENT][POSITIVE] Thank you for calling APO. Have a good day.
[CUSTOMER][NEUTRAL] You too goodbye.
[AGENT][NEUTRAL] Bye.