AccountId: 011433970860
ContactId: 5b7c996c-6a7f-41ed-8b3f-3b5d82b0a563
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 243139 ms
Total Talk Time (AGENT): 83462 ms
Total Talk Time (CUSTOMER): 75394 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/5b7c996c-6a7f-41ed-8b3f-3b5d82b0a563_20250604T14:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII]. I'm calling from provider office to check on the claim status. Can you help with the status of the claim?
[AGENT][NEUTRAL] All right, [PII]. Happy to check on the claim. What is the policy number?
[CUSTOMER][NEUTRAL] It's 01780684 M as in Mary, L as in Lima, number 8.
[AGENT][POSITIVE] Thank you. And do you have a good callback number?
[CUSTOMER][NEUTRAL] It's [PII]. It's a direct line, no extension.
[AGENT][NEUTRAL] Thank you. And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and the date of birth would be [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] So [PII] and the bill amount would be $2,196 even.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] So we did receive a claim for the state of service, claim was received on [PII].
[AGENT][NEUTRAL] The claim was denied on [PII].
[AGENT][NEUTRAL] The denial was benefits are only payable if major medical provides benefits.
[AGENT][NEUTRAL] We're the members secondary.
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] Sorry, ma'am, can you repeat again? I did not reason.
[AGENT][NEUTRAL] Claim was denied due to benefits are only payable if major medical provides benefits.
[CUSTOMER][NEUTRAL] This is the reason?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sorry, can you explain it to why it's uh not payable.
[AGENT][NEUTRAL] So we're the members secondary insurance. This will pick up deductible, co-pay, co-insurance that the primary does not.
[AGENT][NEUTRAL] So this is only payable if their major medical pays the benefit. We don't show that their major medical covered anything, therefore there was nothing payable.
[CUSTOMER][NEUTRAL] OK. If uh, if a primary pays any some amounts and uh coin insurance amounts paid by the secondary, not for the total amount, right?
[AGENT][NEUTRAL] Right, we don't show their primary paid anything.
[CUSTOMER][NEUTRAL] OK. Can you provide me the primary like member ID?
[AGENT][NEUTRAL] We do not have that information. You would have to contact the insured.
[CUSTOMER][POSITIVE] Mm thank you for that, ma'am. Uh.
[CUSTOMER][NEUTRAL] Is the claim number is 3601346, is it right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] May I have your good name, please?
[AGENT][NEUTRAL] My name, is that what you were asking for?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] My name is [PII], that's [PII]
[CUSTOMER][POSITIVE] Thank you and uh reference number for this one.
[AGENT][NEUTRAL] Call references my name with today's date.
[CUSTOMER][POSITIVE] Thank, thank you for that and uh have a nice day. Take care.
[AGENT][NEUTRAL] You too bye bye.