AccountId: 011433970860
ContactId: 83bde379-8796-4996-a6cb-4b7ccd8590d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 513190 ms
Total Talk Time (AGENT): 259780 ms
Total Talk Time (CUSTOMER): 85158 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/83bde379-8796-4996-a6cb-4b7ccd8590d3_20250513T12:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, I have a claim that, um, is being denied, um, and saying that I have another insurance.
[CUSTOMER][NEUTRAL] So I needed to verify that with you guys if that's not the case.
[AGENT][NEUTRAL] OK, let me take a look. Do you have a policy number we can look it up or a claim number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, not with me. Can I give you my name or let me see.
[AGENT][NEUTRAL] Mhm yeah we can look you up by name.
[CUSTOMER][NEUTRAL] What other information can I give you?
[AGENT][NEUTRAL] Yeah, we can look you up by name or social, whichever you would prefer to give me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Is your last name spelled [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And first name is [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What state do you live in?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much. [PII], can I get your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then I need the full address in [PII], please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you so much. So the claim um that you're speaking of, do you remember what the date of service was? Is it a recent claim under you?
[CUSTOMER][NEUTRAL] No, it's um, it was from last year, it's an MRI.
[CUSTOMER][NEUTRAL] Uh, and it's Pembroke Pink.
[AGENT][NEUTRAL] Was it under your name, a claim under you?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you remember kind of what time of frame of last year? Was it in the beginning of the year, middle, end?
[CUSTOMER][NEUTRAL] Mm, I don't remember.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just saw it was last year.
[CUSTOMER][NEUTRAL] What it's not coming up?
[AGENT][NEUTRAL] Well, there's there's quite a few different claims, so I just need.
[AGENT][NEUTRAL] To check and see.
[CUSTOMER][NEUTRAL] I can try to see if I find those.
[AGENT][NEUTRAL] I see one from Pembroke Imaging.
[CUSTOMER][NEUTRAL] Yeah, that one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's $250.
[AGENT][NEUTRAL] So on this one, I do show the claim was denied. It's asking for an explanation of benefits from your primary.
[CUSTOMER][NEUTRAL] OK, what do you mean explanation of benefits?
[AGENT][NEUTRAL] So, um, who is your primary insurance?
[CUSTOMER][NEUTRAL] Cigna
[AGENT][NEUTRAL] Or who, OK, so we need an explanation of benefits from Cigna from that date of service because this policy is your secondary policy.
[AGENT][NEUTRAL] So any time that any services are done, we need to see what Cigna covered and what the remaining balance is as far as any responsibility for you and that's why we need the explanation of benefits from them.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, how do I get that over to you guys? I mean, it's big now.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] You can Cigna would have an app, um, an online portal, you should be able to go into that. Your explanation of benefits are always available for you. Uh, go to that date of service. It looks like it was [PII].
[AGENT][NEUTRAL] Once you find that explanation of benefits you can send it to us via fax you can mail it or you can upload it on our online service center.
[CUSTOMER][NEUTRAL] OK, how do I upload it?
[AGENT][NEUTRAL] Um, let me
[CUSTOMER][NEGATIVE] It's the first time I have to do this. I don't, I don't understand what's going on. I've never had to do this before.
[AGENT][NEUTRAL] Yeah, I mean, it's pretty standard anytime on a secondary policy that we have to see what your primary pay before we can pay anything.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] The email that you have.
[CUSTOMER][NEUTRAL] I again, I've never had to do this before.
[AGENT][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, is the um is the email address on file the [PII] a good email?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me see if you ever even logged in before.
[AGENT][NEUTRAL] And I can just send you an email with some instructions on this, but I need to see if you've ever logged in, so give me just a second, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. It doesn't look like you've ever logged in before.
[AGENT][NEUTRAL] OK, so what I can do is I'm gonna send you an email with a user guide on how to create an online profile and go in and file a claim and do all of that. All that needs to be submitted is just the explanation of benefits that's all it's requesting nothing else.
[AGENT][NEUTRAL] So you can just upload that and that'll be in the instructions and then the claim will just be processed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Did you have any other questions, concerns you can think of?
[CUSTOMER][NEUTRAL] The explanation of benefits is, is it like for that date or is it just like a general explanation of benefits?
[AGENT][NEUTRAL] It would be for that date of service, that's what you you're gonna need.
[CUSTOMER][NEUTRAL] OK, and it's [PII]?
[AGENT][NEUTRAL] Mhm. So it should show that provider on it. It should show the amount that the provider billed to Cigna.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And then it'll show the co-insurance, deductible, co-pay, all of that, patient responsibility.
[AGENT][POSITIVE] That's exactly what we need.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right, [PII]. You're welcome. Bye-bye.
[CUSTOMER][POSITIVE] All right, thank you for your help.