AccountId: 011433970860
ContactId: a820102d-fe30-4ffa-99b2-29cc3e61a6a4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 537289 ms
Total Talk Time (AGENT): 82651 ms
Total Talk Time (CUSTOMER): 142199 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/a820102d-fe30-4ffa-99b2-29cc3e61a6a4_20250610T20:37_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], it's [PII] with APL uh care team.
[CUSTOMER][NEUTRAL] Uh, I have someone who's needing assistance with claim for a claim policy number is 1954795.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, it's for the data service of [PII], and he gave me the claim number of 353.
[CUSTOMER][NEUTRAL] 7106 and I'm showing that it was denied, but then I'm seeing that the total benefit of this claim was paid in the amount of $745. It looked like it was denied because they needed the primary EOB and then I, I, I saw the primary EOB in OnBase and so I just wanted to know if it was still denied or if you could help look into that.
[AGENT][NEUTRAL] OK, one second.
[AGENT][NEUTRAL] Is the insured on the phone or the provider?
[CUSTOMER][NEUTRAL] Uh, the provider.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah, looks like we shouldn't have paid it, but you send them on over.
[CUSTOMER][POSITIVE] Great. Thank you so much, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright [PII] I have claim support on the line that can help you with that. Mhm. OK, alright, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Uh, my name is [PII]. I'm looking for the uh UV status which we have sent it to you to review the claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said this is a UB?
[CUSTOMER][NEUTRAL] EOB explains some benefits from the primary insurance.
[AGENT][NEUTRAL] OK, I'm sorry, I thought you said UB. I'm sorry. OK, alright.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] OK, it looks like on that claim, uh, we did not make a payment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Because benefits are only payable if the major medical provides benefits on the claim, so it looks like the bill service was not covered by the health plan.
[CUSTOMER][NEUTRAL] No, it was the bill charges, the service was uh.
[CUSTOMER][NEUTRAL] Um, process and allowed amount, the whole charges they allowed for the whole bill charges and was applied to patients deductible.
[AGENT][NEUTRAL] OK, because it looks like it says.
[CUSTOMER][NEUTRAL] So it doesn't, yeah, it doesn't show there is an uh no any um non-covered charges denied on the claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] From the primary.
[AGENT][NEUTRAL] OK, give me a second, let me look at this one.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I know we are.
[AGENT][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] OK, give me just one second, OK?
[AGENT][NEUTRAL] To review this one, give me one second.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Hello, sir. Thank you for holding.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, is there either way that I can get a callback number and let me review this one because we've gotten several EOBs, some have remarks and codes on it and some do not. Is there any way I can give you a call back?
[AGENT][NEUTRAL] It, it'll be this evening.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, but um, the, uh, I'm working from home, so the callback number is at the office. So I don't think it's possible, but um you can try.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If that is workable, if you can call back, uh, try this number, [PII], the calling number.
[AGENT][NEUTRAL] And you said [PII]?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, and can I get your name again sir?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, well you can give me just a second to uh go through all this information and I'll give you a call back.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, sure, go ahead.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] All right, bye bye.
[CUSTOMER][POSITIVE] Thank you. Bye.
[AGENT][NEUTRAL] All right, bye bye