AccountId: 011433970860
ContactId: 6ead23bc-0b67-4d55-9719-05836d44f3c7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 404119 ms
Total Talk Time (AGENT): 161038 ms
Total Talk Time (CUSTOMER): 96367 ms
Interruptions: 2
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/6ead23bc-0b67-4d55-9719-05836d44f3c7_20250409T18:32_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from the product office to check on the claim status.
[AGENT][NEUTRAL] Did you say
[CUSTOMER][NEUTRAL] Pro office.
[AGENT][NEUTRAL] Your name is [PII] or [PII]?
[CUSTOMER][NEUTRAL] Yes [PII]
[AGENT][NEUTRAL] What is your name again?
[AGENT][NEUTRAL] And [PII], my name is [PII]
[CUSTOMER][NEUTRAL] [PII], [PII]
[AGENT][NEUTRAL] OK, and my name is [PII]
[AGENT][NEUTRAL] And [PII], you're needing to check claim status, is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII].
[AGENT][NEUTRAL] OK, thank you. And you have one clo on, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, OK. I can help you. What is the patient's policy number, please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The patient's policy number is
[CUSTOMER][NEUTRAL] 024
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 659-11, M for Mike, L for Lima, and H.
[AGENT][NEUTRAL] 8, OK.
[AGENT][NEUTRAL] Thank you, one moment while I get the member's information pulled up, please.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the date of birth is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Yeah, you're welcome.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what is the date of service and total bill amount for our place max?
[CUSTOMER][NEUTRAL] Yeah, sure, ma'am. The data services.
[CUSTOMER][NEUTRAL] [PII] and the total bill amount is?
[CUSTOMER][NEUTRAL] $136 even.
[AGENT][NEUTRAL] What is, what is
[AGENT][NEUTRAL] $136 is that correct?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yes, ma'am. $136.
[CUSTOMER][NEUTRAL] Even
[AGENT][POSITIVE] OK, thank you. OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah, you
[AGENT][NEUTRAL] OK, so this claim was received on 10-17-2024.
[AGENT][NEUTRAL] It was processed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And denied on 10-21-2024.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 351.
[AGENT][NEUTRAL] 9874.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And again, this claim was denied.
[CUSTOMER][NEUTRAL] A
[AGENT][NEUTRAL] And the
[AGENT][NEUTRAL] Reason for the denial on the claim, Max?
[CUSTOMER][NEUTRAL] Yeah, yes, ma'am.
[AGENT][NEUTRAL] States.
[AGENT][NEUTRAL] Benefits are payable only if your major medical insurance provider provides benefits.
[AGENT][NEUTRAL] If this claim is later paid by your major medical insurance.
[AGENT][NEUTRAL] Place in the explanation of benefits, benefits were paid.
[CUSTOMER][NEUTRAL] So claim was dinner for the
[CUSTOMER][NEUTRAL] Medical explanation benefits.
[AGENT][NEUTRAL] It states according to the OK.
[AGENT][NEGATIVE] Per the information we received, it did not show that her primary insurance had provided benefits.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] States that have benefits that are bene let me sorry [PII], let me read, I'll just read it to you again.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Benefits are payable only.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If your major medical insurance provider provides benefits.
[AGENT][NEUTRAL] If the claim is later paid by your major medical insurance, please send me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The explanation of benefits, showing that benefits were paid.
[CUSTOMER][NEUTRAL] OK, so you need the primary UB to process the claim.
[AGENT][NEUTRAL] If they have paid, if the primary insurance provided any benefits?
[AGENT][NEGATIVE] Then yes, what we received showed that they did not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, let me repeat, ma'am. It's uh you need the primary to process the claim. So
[CUSTOMER][NEUTRAL] Correct. You are the secondary for this member.
[AGENT][NEUTRAL] OK, like, I'm.
[AGENT][NEUTRAL] We are the secondary, but this policy only provides benefits if it is covered by the primary.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Insurance as well.
[CUSTOMER][NEUTRAL] Can you just give me one minute.
[AGENT][NEGATIVE] If the major medical doesn't cover it, APO would not cover it either.
[CUSTOMER][NEGATIVE] Bitchfield.
[CUSTOMER][NEUTRAL] OK. Just give me one minute, ma'am.
[AGENT][NEUTRAL] Mhm.