AccountId: 011433970860
ContactId: 6d815292-d5f4-4576-a643-0e02a3d9e1d5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 395010 ms
Total Talk Time (AGENT): 172801 ms
Total Talk Time (CUSTOMER): 174356 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/6d815292-d5f4-4576-a643-0e02a3d9e1d5_20250508T21:55_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, sorry, I didn't catch your name. Can you repeat, can you repeat it one more time, please?
[AGENT][NEUTRAL] Sure, yes. My name is [PII]. That's [PII], last initial [PII].
[CUSTOMER][NEUTRAL] Hi, so this is [PII] and I'm calling from a provider's office. I just need help um on tracking claim status.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Thanks. OK, sure. Yes, I can assist you with claims, Ms. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes, my direct line is [PII].
[AGENT][NEUTRAL] OK, thank you and may I have the name of the facility you're calling from from my note?
[CUSTOMER][NEUTRAL] Yes, I'm calling for provider [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, um, it's gonna be one moment 026 04091.
[AGENT][NEUTRAL] Thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Mhm, it's um [PII] and his date of birth is [PII].
[AGENT][NEUTRAL] Thank you. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] So I have two date of service. The first one is [PII], oh sorry, yeah, it's [PII], and the total bill amount is $160 even.
[AGENT][NEUTRAL] OK, that was [PII] from 160.
[CUSTOMER][POSITIVE] Correct, mhm.
[AGENT][NEUTRAL] All right, let me see if I can find this one. And for future, you can check claim status online through our website at [PII] and that's just optional. And bear with me, let me pull this EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Still waiting on the system, one moment.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] All right, so it looks like we processed the claim on [PII].
[AGENT][NEUTRAL] And the claim was denied. The reason for this denial is indicating that benefits are payable only if major medical insurance provides benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um, can you repeat that one more time? Can you explain it? Sorry, I didn't get it. So yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes. OK. So, um, this is a secondary supplemental plan to the major medical. We pay if major medical pays. So if there is an explanation of benefits indicating that there's an amount applied towards the deductible co-payment and co-insurance, we need that ELB.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, we did submit it with the EOB, um, his insurance was, uh, Cigna. That's why we mailed that claim because we already got the denial from the, uh, from Cigna.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK, where did they deny completely because if they don't pay, we don't pay. Let me check that you'll be.
[CUSTOMER][NEUTRAL] OK, let me, OK, yeah, let me also check that. OK, let me see, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, so just uh.
[AGENT][NEUTRAL] OK, so yeah, it looks like they denied due to network.
[CUSTOMER][NEUTRAL] Yeah, looks like
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so that's how it works. So if, yeah, the primary doesn't pay, so you, you, you're not gonna pay. Yeah, yeah, alright, uh, yeah, just checking again the coup like the 416, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And you don't pay.
[AGENT][POSITIVE] Correct. Mhm.
[AGENT][NEUTRAL] Mhm. It's OK.
[AGENT][NEUTRAL] And let me know if you need that claim number.
[CUSTOMER][NEUTRAL] Yeah, yeah, OK, let me get that same number, OK.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] OK, the claim number is 3596408.
[CUSTOMER][NEUTRAL] 640835-96408. OK and then can you also check this um another claim for same uh patient?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Same patient, yes. What's the date of service?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII] same bill amount so most likely it's gonna be the same.
[AGENT][NEUTRAL] Mhm. The same denial. Mhm. Yes, I, I have the claim number you need it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright then, OK, so yeah, OK, I'll just don't work. So OK, so if there's no payment, uh oh yeah, so there's no, it doesn't say there's not at all.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, alright, OK, thanks, um, so can I, um, do you provide a reference number?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information? OK.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] No, I got it. It's [PII] last name initial is [PII]
[AGENT][POSITIVE] That's, um, yes, that's correct. Mhm, yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Alright, OK, thank you so much for your help.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. Thank you for calling APL. You have a good afternoon.
[CUSTOMER][NEUTRAL] 00, I'm sorry, sorry, sorry, sorry, before I let you go, can I also get the claim number for the um for [PII]?
[AGENT][NEUTRAL] Yeah, uh-huh, go ahead, go ahead. Yeah. Uh-huh.
[AGENT][NEUTRAL] Yes, yes, yes. I got it here. It's OK. The claim number is 3,596,540.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 6542 OK 359-6540.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][POSITIVE] All right, OK, alright, thanks again.
[AGENT][POSITIVE] You're welcome. Have a good afternoon. You as well. Bye-bye.
[CUSTOMER][POSITIVE] You have a good day.
[CUSTOMER][NEUTRAL] All right bye bye.