AccountId: 011433970860
ContactId: 695ad968-a39b-4066-be20-9e0b0938de4c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 114199 ms
Total Talk Time (AGENT): 64719 ms
Total Talk Time (CUSTOMER): 59260 ms
Interruptions: 2
Overall Sentiment: AGENT=0, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/695ad968-a39b-4066-be20-9e0b0938de4c_20250124T19:04_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], it's [PII]. Look, I'm not transferring a call, but I just have a, I've had a brain cramp. If a provider filed a claim but didn't include the primary EOB and now the insured sends it in.
[CUSTOMER][NEUTRAL] Would benefits if payable be go to the provider or to the insured?
[AGENT][NEUTRAL] If we catch it, we are supposed to pay it to the provider and then deny the claim and tell the insured, hey, we pay the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, let me, I don't know, maybe I didn't say that right. So the primary insurance company, I mean, no, the provider files the claim with APL.
[CUSTOMER][NEGATIVE] But only sent the claim and not the primary insurance EOB.
[AGENT][NEGATIVE] Right. And then we denied the claim and asked for the EOB. But then in the meantime, the insured sent it in.
[CUSTOMER][NEUTRAL] And the insured
[CUSTOMER][NEUTRAL] Uh-huh, and the insured sent in.
[CUSTOMER][NEUTRAL] The insured sends it.
[AGENT][NEUTRAL] We're supposed to catch it if we catch it because I've gotten dinged on this a few times to where I just paid the, you know, I didn't see that the provider filed first and we asked for the EOB I just paid the insurer, but if that's why I said if we catch it, so if we catch it, we're gonna pay the provider and then deny the claim and let the insured know, hey, we, we gave the money to the provider.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, so I'll just tell her that typically it should go to the provider, which I've already done, but then I was like I'm not sure.
[CUSTOMER][NEGATIVE] I was like, I don't know. I, I mean, I just froze.
[AGENT][NEUTRAL] Yeah, it, it's just a, it's, it's a, it's something that the, the processor has to catch.
[CUSTOMER][NEUTRAL] OK, but it, it, it should, uh, so that's what I already to send it.
[AGENT][NEUTRAL] But that's the rule. That's the rule, but sometimes we don't catch it and then we pay the insured. So, but the rule is, yes, if we get an EOB and, and they file first, they, they have priority to get that money.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, you are the mom. Thank you so much. OK, all right, you too. Bye.
[AGENT][POSITIVE] All right, thank you. You have a good day.
[AGENT][NEUTRAL] Mhm