AccountId: 011433970860
ContactId: 6d311971-5388-4550-be3f-e36fae9c4a51
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 277839 ms
Total Talk Time (AGENT): 132221 ms
Total Talk Time (CUSTOMER): 104254 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/6d311971-5388-4550-be3f-e36fae9c4a51_20250102T18:35_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, I am calling from a provider's office and we have uh um I guess explanation of benefits and it has some verbiage on here we're not quite sure what what is needed.
[AGENT][NEUTRAL] Yeah, let me take a look at that for you. Do you have the policy number handy?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Do it has that it is 02515409.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You betcha. And your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII] and it is [PII].
[AGENT][POSITIVE] Perfect thank you so much and then do you mind if I ask for that claim number?
[CUSTOMER][NEUTRAL] Um, let me see here. I have 353-073-8.
[AGENT][POSITIVE] Wonderful. Thank you so much. And it looks like it was denied.
[AGENT][NEUTRAL] OK, um, so.
[AGENT][NEUTRAL] So it looks like the insured, um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Did not have.
[AGENT][NEUTRAL] Any benefits
[AGENT][NEUTRAL] For that um date of service and so it's weird but this like the group is set up to allow people to.
[AGENT][NEUTRAL] Miss like periods of time with their coverage, but without losing their overall coverage, and so they're covered at like
[AGENT][NEUTRAL] Like their range is different. I don't know if that makes sense, um, but it looks like for the date of service for that procedure what they had done that they did not have coverage, um.
[AGENT][NEUTRAL] With this policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Do you know like what a range of when um it it went out of effect and then came back effect just because they have um Medicaid insurance secondary so with this denial they probably wouldn't process.
[AGENT][NEUTRAL] OK, um, so.
[CUSTOMER][NEUTRAL] If we build them as secondary.
[AGENT][NEUTRAL] I have like their coverage um so I only can see it through the like through the month, um, so I'm looking at 722, 24 through 1027 24 listed as.
[AGENT][NEGATIVE] Their overall coverage with us um and then it's broken down on a weekly basis and I cannot see that.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't know. Yeah, I actually have no idea how Medicaid works, but this is the just a limited supplemental policy, and I'm not sure if we would be impacting Medicaid.
[CUSTOMER][NEUTRAL] OK, yeah, we don't see this, uh, this first time I've seen this. That's why we weren't sure, but usually if we build them as secondary and it says waiting for information from them like member or something then then they say well we need a.
[AGENT][NEUTRAL] No, it's OK. It's
[CUSTOMER][NEGATIVE] Clear explanation that's denied.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] But with that I can, I can see, say that it was termed at that time and we could probably just bill Medicaid Primary.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, all right, I think that is all I would need though um do you have call references by any chance?
[AGENT][NEUTRAL] Yes, absolutely. The call references can be my name, [PII], [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, that sounds good. OK, thank you so much.
[AGENT][NEUTRAL] Hey
[AGENT][NEUTRAL] And um, so sorry, ma'am, just one more quick question. What was the last three digits on that claim one more time? I didn't take it down from my notes and I already left the screen. I'm sorry.
[CUSTOMER][NEUTRAL] Um, the claim number was 353-073-8.
[AGENT][POSITIVE] 38 perfect thank you so much I really appreciate that.
[CUSTOMER][POSITIVE] You're welcome thanks.
[AGENT][POSITIVE] All right you take care. Have a great day.
[CUSTOMER][NEUTRAL] OK bye.
[AGENT][NEUTRAL] Bye bye.