AccountId: 011433970860
ContactId: 96f597d3-3fb1-44df-98fa-9a012eb4c0f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 261899 ms
Total Talk Time (AGENT): 118682 ms
Total Talk Time (CUSTOMER): 68063 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/96f597d3-3fb1-44df-98fa-9a012eb4c0f6_20250421T22:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I have a question about my claim number.
[AGENT][NEUTRAL] OK, I'm happy to check on a claim. You have the claim number you said?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Let me uh grab that from you. Go ahead.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] 359-053-2
[AGENT][NEUTRAL] Alright, one moment please.
[AGENT][NEUTRAL] All right. And I'll need to just verify a few things on the policy. One moment.
[AGENT][NEUTRAL] Can I get the name and date of birth on the policy?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And then lastly [PII] can I just get the address on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like the claim was denied. It did, um, it is asking for the explanation of benefits from the primary insurance.
[AGENT][NEUTRAL] Uh, so we need that for further.
[CUSTOMER][NEUTRAL] OK, I, it wasn't, it wasn't for the office visit. I'm not sure why I have office visit on there. It was for the MRI that I paid for.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's on that same paper that I faxed, it has the amount that I paid for on the MRI.
[CUSTOMER][NEUTRAL] So I'm not sure why they would be the explanation for that.
[AGENT][NEUTRAL] Did you not use your primary insurance at all?
[CUSTOMER][NEUTRAL] Yeah, they paid for part of it and I paid for the other part.
[AGENT][NEUTRAL] So we have
[CUSTOMER][NEUTRAL] I paid out of pocket that amount.
[CUSTOMER][NEUTRAL] And it shows that I paid for that.
[CUSTOMER][NEUTRAL] On that bill that I just faxed you.
[AGENT][NEUTRAL] So as a secondary, we have to have an explanation of benefits from the primary to see exactly what the primary covered, um, as far as the deductible co-pay and co-insurance on these claims, that's why it's being requested.
[CUSTOMER][NEUTRAL] Why would you need that when it's the you pay for the 1st $1000 out of pocket?
[AGENT][NEUTRAL] It's part of having the secondary to cover that deductible co-pay or co-insurance. The claims examiners need to see exactly what they paid to process the claim.
[CUSTOMER][NEUTRAL] That shows that on the information I gave you.
[AGENT][POSITIVE] I'm happy to get somebody on the line that's an examiner, [PII], and maybe they can explain it better to you. Give me just one moment please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] over in customer care. How are you?
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][NEUTRAL] Hey, I'm good. Um, I have an insured on the line and she has a question about a claim. I was trying to explain to her that we need an explanation of benefits from her primary, and she's kind of arguing back with me as far as why, and I tried to explain it, but I may not be doing a good job. So could you maybe help her?
[CUSTOMER][NEUTRAL] And what's the policy number?
[AGENT][NEUTRAL] 1,462,920 for [PII] and then I have the claim number too.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] Claim number is 359-053-2.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright you can send her on over.
[AGENT][POSITIVE] Thank you. Here she comes, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?