AccountId: 011433970860
ContactId: 89fd16de-5e7d-4ca0-8387-5d9af81155c0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 190899 ms
Total Talk Time (AGENT): 66239 ms
Total Talk Time (CUSTOMER): 86052 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/89fd16de-5e7d-4ca0-8387-5d9af81155c0_20250305T21:35_UTC.wav
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[AGENT][NEUTRAL] For calling
[AGENT][NEUTRAL] I'm sorry, thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I'm sorry, your name is [PII]?
[AGENT][NEUTRAL] It's [PII], yes ma'am.
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and I am calling from Exact Sciences uh Laboratories, and I am wondering if you could help me with a claim that's denied.
[AGENT][NEUTRAL] Sure, I can help you, [PII]. Do you have the policy number and the claim number?
[CUSTOMER][NEUTRAL] Yes, um, the subscriber number is 01138746.
[AGENT][NEUTRAL] Mhm and a good phone number?
[CUSTOMER][NEUTRAL] And I'm looking, oh, sorry, go ahead.
[AGENT][NEUTRAL] A good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII], excuse me, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And do you have a claim number?
[CUSTOMER][NEUTRAL] You know, I just, I'm looking for it and sometimes it stands right out and other times it doesn't.
[AGENT][NEUTRAL] Or the date of service I can search it by either or.
[CUSTOMER][NEUTRAL] Yeah, I, I, OK, it's [PII], and it's $681.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I see that claim. Give me a moment to pull that up and then I can help you with the status of that and you're just basically needing clarification of the denial?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah, I, uh, it's just a CL 45, so I would need more information, and I'm also wondering if American Public Life is primary or if United Healthcare is primary.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. United Healthcare, the major medical would be primary. This plan is secondary.
[CUSTOMER][NEUTRAL] OK. That's what I was thinking, so.
[AGENT][NEUTRAL] And then.
[AGENT][NEUTRAL] Mhm and then under this policy that looks like an independent lab charge?
[CUSTOMER][NEUTRAL] Yes mhm.
[AGENT][NEUTRAL] So under this policy, independent laboratory is not covered and that was the reason for the denial.
[CUSTOMER][NEUTRAL] OK, OK, but, um, UHC would be primary anyway, so I'll send it to them.
[AGENT][POSITIVE] Correct, yes, yes, ma'am. Yes ma'am.
[CUSTOMER][POSITIVE] OK, [PII], thank you so much. Do you have a reference number for the call?
[AGENT][NEUTRAL] Uh, not a reference number, uh, per se, but you, you can use my name in today's date, um, as tracking or, you know, as a reference for today's call if you would like.
[CUSTOMER][NEUTRAL] OK, I'll do that.
[CUSTOMER][POSITIVE] OK, that works perfectly. Thank you, [PII]. I appreciate your help and I hope you have a good rest of your day.
[AGENT][POSITIVE] Absolutely [PII] thank you for calling APL. Have a good day as well.
[CUSTOMER][POSITIVE] Thank you. Goodbye.
[AGENT][NEUTRAL] Uh bye.