AccountId: 011433970860
ContactId: 6ee4e9c7-42d3-467e-84b6-08bff25c624c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 249190 ms
Total Talk Time (AGENT): 59078 ms
Total Talk Time (CUSTOMER): 108865 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/6ee4e9c7-42d3-467e-84b6-08bff25c624c_20250417T20:22_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from the provider's office regarding a claim.
[AGENT][NEUTRAL] OK, yeah, I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, uh, it will be [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yeah, um, I have.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 024
[CUSTOMER][NEUTRAL] 46516.
[AGENT][NEUTRAL] OK, and patient name and date of birth?
[CUSTOMER][NEUTRAL] That will be
[CUSTOMER][NEUTRAL] I see [PII].
[CUSTOMER][NEUTRAL] Birthday is [PII].
[AGENT][NEUTRAL] OK, and what was the date of service for that claim?
[CUSTOMER][NEUTRAL] This will be for 731 of $24. Total bill is $277.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] OK, looks like we received 127 25 and that was processed 128 25.
[AGENT][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] You said process a 126 to 25, did I hear that correct?
[AGENT][NEUTRAL] Uh, yes. Um, looks like this is not a covered expense under the policy.
[CUSTOMER][NEUTRAL] Not cover expense.
[CUSTOMER][NEUTRAL] Under
[CUSTOMER][NEUTRAL] Uh, the policy, um, let's see here. This is an office visit. How is it not a covered benefit I guess I'm trying to understand that.
[AGENT][NEUTRAL] This is a secondary supplemental policy, um, office visits aren't covered under the policy.
[CUSTOMER][NEUTRAL] So often. Um, so you guys are secondary, you said?
[AGENT][POSITIVE] Yes we are.
[CUSTOMER][NEUTRAL] secondary supplement plan you.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] That's weird.
[CUSTOMER][NEUTRAL] Do you guys show, do you guys show you guys a primary or you guys are secondary because I look at here you guys a primary for this number.
[AGENT][NEUTRAL] Uh, there had to have been a primary because we wouldn't be able to process the claim. Let me see who it is.
[CUSTOMER][NEUTRAL] That's weird.
[AGENT][NEUTRAL] Uh, Blue Cross Blue Shield.
[AGENT][NEUTRAL] South [PII].
[CUSTOMER][NEUTRAL] Blue Cross Blue Shell is primary to you guys?
[AGENT][NEUTRAL] That's their primary insurance, yeah.
[CUSTOMER][POSITIVE] That's great.
[CUSTOMER][NEUTRAL] Uh, that is weird because this is so currently now.
[CUSTOMER][NEUTRAL] OK, I guess I have to look into this because it looks like it just came straight to you guys, which is.
[CUSTOMER][NEUTRAL] Yeah, looks like it just came straight to you guys. We didn't have.
[CUSTOMER][NEUTRAL] Uh, patient Blue Cross Blue Shield, South Carolina on here. Do you by chance have their ID number or you don't?
[AGENT][NEUTRAL] Uh, no, I don't. I'm sorry.
[CUSTOMER][NEUTRAL] OK, that's OK. Um, I will get with the patient regarding this then. Can I get a reference number, uh, [PII]? Is there a claim number I can take down as well?
[AGENT][NEUTRAL] Oh, that's
[AGENT][POSITIVE] Uh yes, I can get that back.
[CUSTOMER][NEUTRAL] For this one?
[CUSTOMER][NEGATIVE] I don't think we received the EOB for this because it just seems like you guys did to me it looks like the way they stated is like they never.
[CUSTOMER][NEGATIVE] You just never got the clean.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Claim number is 3556747.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the reference number.
[AGENT][NEUTRAL] Uh, reference number is my name and today's date. And can I help with anything else today?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] No, that should be it. Thank you, [PII]. You have a good day.
[AGENT][POSITIVE] OK, thank you for calling APL you as well.
[CUSTOMER][NEUTRAL] Bye bye.