AccountId: 011433970860
ContactId: 9a3a3030-8d1e-4321-a48e-578fc762f17c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 236080 ms
Total Talk Time (AGENT): 69907 ms
Total Talk Time (CUSTOMER): 80802 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/9a3a3030-8d1e-4321-a48e-578fc762f17c_20250402T16:27_UTC.wav
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[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm calling from Mercy Hospital. My name is [PII]. Checking on claims, and I'm sorry, your voice is very low. I can't.
[CUSTOMER][NEGATIVE] Not audible.
[AGENT][NEUTRAL] OK, can you hear me?
[CUSTOMER][NEUTRAL] Yes, no, it's yeah.
[AGENT][NEUTRAL] And [PII], do you have a good callback number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I can check claim. You said claim status, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] All right. It is 02279404.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] And what was that date of service?
[CUSTOMER][NEUTRAL] Inpatient claim from [PII] [PII].
[AGENT][NEUTRAL] And the bill charges?
[CUSTOMER][NEUTRAL] $7,442.82.
[AGENT][NEUTRAL] OK. Let me check.
[AGENT][NEUTRAL] Uh, it looks like we denied the claim. Benefits are only payable if the major medical insurance provides benefits. If it's later paid by major medical, please provide the explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So you need the Medicare primary UV?
[AGENT][NEUTRAL] Yeah, showing that it was considered.
[AGENT][NEUTRAL] By Medicare.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, um, one moment, uh, like, is it like
[CUSTOMER][NEUTRAL] American Public Life is uh secondary to Medicare or any other insurance because from my end a member has a Blue Cross as a primary.
[AGENT][NEUTRAL] Yeah, so this is a gap policy, so it's a supplemental secondary policy, and we process based on, you know, after the primary pays or considers the claim, we'll potentially pick up co-pay deductible co-insurance.
[AGENT][NEUTRAL] So it's it's a secondary policy.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] So this is a gap secondary policy and it will cover the primary co co co-insurance deductible.
[AGENT][NEUTRAL] Yes, as long as it's a covered benefit under this policy as well, yes.
[CUSTOMER][NEUTRAL] Sure. And the mailing address, let me validate it is [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And the time frame to submit a claim.
[AGENT][NEGATIVE] Uh, there's no timely filing.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, and do we have a call reference number?
[AGENT][NEUTRAL] Call reference number just be my first name, [PII], first initial last name [PII], and today's date. Can I help with anything else today, madam?
[CUSTOMER][POSITIVE] No, that's all for now. Thank you so much, [PII], for your assistance. That's have a great day. Bye bye.
[AGENT][POSITIVE] Thanks for calling APLU as well.