AccountId: 011433970860
ContactId: 71e78353-9908-46f1-84e5-9c93d0e6a589
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 241940 ms
Total Talk Time (AGENT): 105467 ms
Total Talk Time (CUSTOMER): 101560 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/71e78353-9908-46f1-84e5-9c93d0e6a589_20250319T15:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII]. initially my last name is [PII]. I'm calling from provider's office. I need to check on denied claim.
[AGENT][POSITIVE] Alright, well [PII], I'll be glad to help you. Go ahead and give me a good policy number.
[CUSTOMER][NEUTRAL] Um, the policy number is 02552057 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Alright, [PII], thank you for that. And while I'm pulling this up, go ahead and give me a good return telephone call number, please, sir.
[CUSTOMER][NEUTRAL] OK. It is [PII] is the extension. Could you please spell your name for me?
[AGENT][NEUTRAL] I sure will. [PII] spelled [PII]
[CUSTOMER][NEUTRAL] All right, and initial your last name?
[AGENT][NEUTRAL] Oh, and what's your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Member's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Alright, thank you for that information, [PII]. You said you was gonna check on a denied claim. What is the data service, please, sir?
[CUSTOMER][NEUTRAL] Um, the dealer service is [PII]. The bill amount is $349 even.
[AGENT][NEUTRAL] Alrighty, hold on just a moment for me. Let me get that pulled up. Let's see.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] About $349 looks like we do have that claim in house. We need the primary.
[AGENT][NEUTRAL] Explanation of benefits in order to process this claim. We are just a medical supplemental plan.
[CUSTOMER][NEUTRAL] Understood um.
[AGENT][NEUTRAL] You want to fax it over to us?
[CUSTOMER][NEUTRAL] Yes, and also, can you help me out when was the last time you we updated the coordination of benefit?
[AGENT][NEUTRAL] We don't coordinate it, we're just a medical supplemental plan.
[AGENT][NEUTRAL] We don't, we don't keep who they have on our system, mm mm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, so you're saying that there's, uh, I mean COB is not updated cannot be, uh, done by your end.
[AGENT][NEUTRAL] Yeah, we have to have that primary uh company's uh explanation of benefits because we're just our medical supplemental plan.
[CUSTOMER][NEUTRAL] No, I understood that, uh, you there's a medical supplement plan, but I'm asking.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I can't, I can't hear you. I can't hear you.
[CUSTOMER][NEUTRAL] OK. Uh, am I audible now?
[AGENT][NEUTRAL] OK, better.
[AGENT][POSITIVE] Yes, that's better. I can hear you now.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. So I'm saying that um
[CUSTOMER][NEUTRAL] Uh, there's COB, not the, uh, explanation of, of benefit. I'm asking about the coordination of benefit. Uh, was any letter sent to patient regarding this?
[AGENT][NEUTRAL] Yes, patient is aware that we need that EOB. Yes sir. So is your office, you should get an EOB asking for that information. Let me give you that claim number.
[CUSTOMER][NEUTRAL] Yes, and also can you help me out when was the COP letter sent by American uh public life to the member?
[AGENT][NEUTRAL] We do not send a COB letter. We send an explanation of benefits to that insured.
[AGENT][NEUTRAL] Telling them what we need, yeah.
[CUSTOMER][NEUTRAL] OK, so this
[CUSTOMER][NEUTRAL] All right. And that's. So this claim, uh UB has already been sent to the member, uh, and, uh, American Life do not send UV letters.
[AGENT][NEUTRAL] No, we need EOB from the primary, from the doctor's office.
[CUSTOMER][NEUTRAL] Understood. All right, thank you. Uh, what would be the call reference for this?
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] All righty.
[AGENT][NEUTRAL] We do not give call reference number, [PII], but you can use my name in today's date if you need to do so, OK.
[CUSTOMER][POSITIVE] All right, thank you so much and you've been such a great help. Have a great day. Bye for now.
[AGENT][POSITIVE] Well, you as well, and thanks for calling APO [PII]. Bye-bye.