AccountId: 011433970860
ContactId: 9e3c0ca5-9493-4ca5-8b08-fd2e57f4acc8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 269279 ms
Total Talk Time (AGENT): 93090 ms
Total Talk Time (CUSTOMER): 130207 ms
Interruptions: 2
Overall Sentiment: AGENT=1.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/9e3c0ca5-9493-4ca5-8b08-fd2e57f4acc8_20250507T15:26_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APL. This is. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Tampa General Medical Group calling to discuss a claim denial. I need some clarification.
[AGENT][POSITIVE] OK, I'd be glad to help you. Go ahead and give me a good policy number.
[CUSTOMER][NEUTRAL] Uh, the policy number is 023372662.
[AGENT][NEUTRAL] All right, [PII], thank you for that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number, please, ma'am.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Well [PII], thank you so much for all that information. Now your patient's name and date of birth today, please, ma'am.
[CUSTOMER][NEUTRAL] Uh [PII] and it's [PII].
[AGENT][NEUTRAL] Alrighty, thank you for that information. Looks like [PII] is the insured on this medical supplemental plan, and you did say you want to discuss a denial on a claim. What date of service?
[CUSTOMER][NEUTRAL] Uh, the first day of service is [PII].
[AGENT][NEUTRAL] Alright, let me get that pulled up. Let's see.
[AGENT][NEUTRAL] How much is your bill for?
[CUSTOMER][NEUTRAL] It's 400 and $402 even.
[AGENT][NEUTRAL] Well let's see.
[AGENT][NEUTRAL] 38.
[AGENT][NEUTRAL] Yes, ma'am, looks like I have that claim in. Uh, let's see, looks like on the office visit, that's not a covered benefit here, but we will need the primary EOB for the charge for $38.
[CUSTOMER][NEUTRAL] Primary EOB.
[AGENT][NEUTRAL] Mhm. And you can just resubmit that whole entire claim along with that EOB.
[AGENT][NEUTRAL] So we can get that reviewed for you.
[CUSTOMER][NEUTRAL] Uh, if you can ask me why, uh, like what you say primary EOB, so you guys have another insurance listed for this member.
[AGENT][NEUTRAL] Yes ma'am. This is a supplemental plan only. I have primary insurance somewhere else. I'm not sure where, but yeah, we're just a supplemental plan.
[CUSTOMER][NEUTRAL] It's what
[CUSTOMER][NEUTRAL] OK, because I don't see, I, I, I was trying to find when I've seen that deny like I there's another claim for a different data service just a couple of weeks later. I don't see that denial reason it doesn't ask for a pro uh provide a copy of the explanation of benefits from the primary insurance on that one, but this one does, so I was trying to figure out who's the other insurance because I don't see another insurance off of this member, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, you would have to check with that member.
[CUSTOMER][NEUTRAL] And you said that you don't.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, you guys are a supplements, so I'm gonna assume that this other patient,
[CUSTOMER][NEUTRAL] It's the same situation.
[AGENT][NEUTRAL] Yeah, IPO we're just a supplemental plan.
[CUSTOMER][NEUTRAL] Alright, one, give me a moment here. I just wanna.
[AGENT][POSITIVE] That's OK. Take your time, [PII].
[CUSTOMER][NEUTRAL] Just pull this up real quick.
[CUSTOMER][NEUTRAL] 14.
[CUSTOMER][NEUTRAL] I might save you.
[CUSTOMER][NEUTRAL] Asking a question about this as a patient because.
[CUSTOMER][NEUTRAL] It looks like it denied for uh ok let me see the email.
[AGENT][POSITIVE] I don't mind at all.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Come on.
[CUSTOMER][NEUTRAL] I'm just waiting on your website to pull up the remit so I can, yeah, the same thing uh offices are not covered treatment other than sickness injury defined by the policy. Now this one's that's something different.
[AGENT][NEUTRAL] Oh no, OK.
[CUSTOMER][POSITIVE] OK. All righty. I think that was about it. Um, thank you so much for your help.
[AGENT][NEUTRAL] Oh, yes, ma'am.
[AGENT][NEUTRAL] Well, yes, ma'am. [PII], is that all I can help you with?
[CUSTOMER][NEUTRAL] Uh, yes, that's all.
[AGENT][POSITIVE] OK, well, thanks so much for calling APO and you have a great rest of your day, OK?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you, ma'am. Mhm, bye-bye.