AccountId: 011433970860
ContactId: 742db2a5-6466-4717-b11f-f196fda50cec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 867559 ms
Total Talk Time (AGENT): 181795 ms
Total Talk Time (CUSTOMER): 146617 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.2, CUSTOMER=-1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/742db2a5-6466-4717-b11f-f196fda50cec_20250404T12:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I need to check on the claim. Can you please help me on that?
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with claim status. Um first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Policy number is 024.
[CUSTOMER][NEUTRAL] 46538.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Mhm. Yeah, sure.
[CUSTOMER][NEUTRAL] Patient name is [PII], [PII], date of birth.
[AGENT][NEUTRAL] Thank you. Now I need the date of service and bill charges on the claim you're calling about.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The services.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the total bill amount is?
[CUSTOMER][NEUTRAL] $277 even.
[AGENT][NEUTRAL] OK. Yes, sir. We received that claim on [PII].
[AGENT][NEUTRAL] The claim was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3583775.
[AGENT][NEUTRAL] And this claim is denying because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] So you will be generated?
[AGENT][NEUTRAL] Yes, an EOB was generated.
[CUSTOMER][NEUTRAL] OK. Can you please send to my mailing address?
[AGENT][NEUTRAL] Um, we
[CUSTOMER][NEUTRAL] Email?
[AGENT][NEUTRAL] We could fax it to you.
[CUSTOMER][NEUTRAL] Uh-huh, we don't have a fax option. Can you please send it to the email?
[AGENT][NEUTRAL] Um, yes. What's your email address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I have [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what's the rest?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so that's [PII].
[AGENT][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] Not, not [PII] EDU, that's it. And that not to.
[CUSTOMER][NEUTRAL] Once again, please listen carefully. [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] [PII], and then the word [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. [PII] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK, I think I have it now. [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. If you hold on.
[CUSTOMER][NEUTRAL] Can you please send it again? I'm on this.
[AGENT][NEUTRAL] Yes, I'm gonna place you on hold and then send it. OK, and I'll send it to you and um stay on the line to verify if you received it. Please hold.
[CUSTOMER][NEUTRAL] OK, I'm on the system.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, sir. Thanks for your patience. Um, I'm unable to email this to you because of HIPAA, but we can send it through regular mail. What's your mailing address?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. When was the claim received date?
[AGENT][NEUTRAL] We received the claim on [PII] and it processed on [PII].
[CUSTOMER][NEUTRAL] Why the claim must with your name?
[AGENT][NEUTRAL] The claim was denied because office visits are not covered under the policy.
[AGENT][NEUTRAL] On the patient's plans.
[CUSTOMER][NEUTRAL] What is the patient plan type?
[AGENT][NEUTRAL] Secondary gap insurance.
[CUSTOMER][NEUTRAL] Secondary.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] What is that secondary?
[AGENT][NEUTRAL] Secondary.
[AGENT][NEUTRAL] We're not primary, we're the secondary.
[AGENT][NEUTRAL] Secondary coverage.
[AGENT][NEUTRAL] Or supplement.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] The claim was denied for the primary uh.
[CUSTOMER][NEUTRAL] You'll be correct because you're secondary.
[AGENT][NEGATIVE] No, the claim denied because the service that was billed on the claim is not covered under this policy. Office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Because the claim hasn't billed as a primary for you, I think, uh, we have the secondary insurance as Blue Cross Blue Shield. We need to first submit the Blue Cross Blue Shield.
[CUSTOMER][NEUTRAL] And they will pay the office visit and their leftover that will be covered with second insurance, correct?
[AGENT][NEGATIVE] No, it won't be covered by this secondary insurance plan because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] You are the primary or secondary insurance?
[AGENT][NEUTRAL] We're the secondary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have the reference number?
[AGENT][NEUTRAL] The reference number is my name and today's date. My name is [PII]. It's spelled [PII]
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And today's date is your reference number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you and bye-bye.
[AGENT][POSITIVE] Thank you for calling APL.