AccountId: 011433970860
ContactId: 8c92abd7-a8aa-43be-a0ea-8860f2025aa3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 510220 ms
Total Talk Time (AGENT): 150677 ms
Total Talk Time (CUSTOMER): 163911 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/8c92abd7-a8aa-43be-a0ea-8860f2025aa3_20250521T18:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from provider's office to check the claim status.
[AGENT][POSITIVE] Sure I can help you with claim status. Can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] Yeah. Policy number is
[CUSTOMER][NEUTRAL] One second, yeah. 740-155-742013.
[CUSTOMER][NEUTRAL] No, I have the information here.
[AGENT][NEUTRAL] Is that the policy number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. I have 740-155 and what was the rest?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 742013.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I think that's too long to be a policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you see, do you have their insurance card?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Are you, are we able to look them up from their social security number?
[CUSTOMER][NEUTRAL] No. Can you check with the patient's first name, last name?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is their last name? Can you spell it for me, please?
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][NEUTRAL] OK, let me check.
[AGENT][NEUTRAL] And what's the first name?
[CUSTOMER][NEUTRAL] Yeah. First name is [PII]. It is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Mm sorry?
[AGENT][NEUTRAL] Uh, give me just one moment while I look it up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I have [PII] and I don't, I didn't see anything for the last name. Uh, is it [PII]?
[CUSTOMER][POSITIVE] Yeah, correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] And [PII] is the first name?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, give me just a second while I look that up.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I'm not seeing any [PII] on here.
[CUSTOMER][NEUTRAL] It's OK. Can I proceed with the next member ID? I have another patient.
[AGENT][NEUTRAL] You have another patient? OK, give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what's this policy number?
[CUSTOMER][NEUTRAL] It's 02279731.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], it is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm sorry, what was that birthday?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And you're wanting claim status correct?
[CUSTOMER][NEUTRAL] Yes, actually, we know the claim status. Previously it was denied as new primary UOP. So we have checked with patient. Patient stated that patient has Ana initially, but it was termed, and it is enacted during the date of service. Uh, and now American public life is only the only one insurance as and acting as a primary for patient for this patient. Can you check what uh patient is updated on the coordination of benefits or not? If updated, can you send it back for the process?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, it looks like this policy we don't have, we aren't major medical. This policy is a secondary insurance. So if her primary insurance denied the claim, then the claim will get denied on this policy as well because it's secondary gap.
[CUSTOMER][NEUTRAL] 194
[CUSTOMER][NEUTRAL] OK. May I know the exact denial reason?
[AGENT][NEUTRAL] Do you have the claim number or?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The um
[AGENT][NEUTRAL] Data service
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, yeah, data service will be.
[CUSTOMER][NEUTRAL] [PII] it's total bill amount of $2,632 even.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] 25.
[AGENT][POSITIVE] OK, I'm so sorry.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] And you said the amount was how much?
[CUSTOMER][NEUTRAL] It is 1 $2,632 even.
[AGENT][POSITIVE] OK, OK, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment while I look that up.
[AGENT][NEUTRAL] It looks like we received that claim on [PII].
[AGENT][NEUTRAL] It was
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEGATIVE] It was denied because we didn't get an explanation of benefits from her primary insurance carrier. So, if she doesn't have a primary insurance anymore, then this policy won't cover it.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Only uh American public life will act as a secondary, right? It, it, it will not be paid as primary.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, patient need to update the primary insurance details so that we can bill to primary, right?
[AGENT][NEUTRAL] Yes, you'll need to bill primary and then send the primary explanation of benefits.
[CUSTOMER][NEUTRAL] Can I get the claim number and your name and call reference?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3563727.
[AGENT][NEUTRAL] And we don't have call reference numbers, but you can use my name and last initial so [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] What is your name?
[AGENT][NEUTRAL] [PII], last initial, [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you. Have a great day. Bye-bye.
[AGENT][POSITIVE] OK thank you have a great day.