AccountId: 011433970860
ContactId: aeebffd0-0fbe-41c3-8266-c21d7397aa8b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 489959 ms
Total Talk Time (AGENT): 231101 ms
Total Talk Time (CUSTOMER): 189764 ms
Interruptions: 5
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/aeebffd0-0fbe-41c3-8266-c21d7397aa8b_20250401T12:25_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good day [PII]. I'm calling to speak with someone about a claim that I uploaded um to the portal.
[CUSTOMER][NEUTRAL] A secondary
[AGENT][NEUTRAL] OK. Are you the insured that you're, and you're wanting to check claim status?
[CUSTOMER][NEUTRAL] No ma'am, I'm a provider's office calling from provider's office.
[AGENT][NEUTRAL] OK, but you're needing to check claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, ma'am, I can help you with.
[CUSTOMER][NEUTRAL] I last I last spoke with [PII].
[AGENT][NEUTRAL] Who
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mm, there's no one here by that name, but I'll be glad to try and help you. So who am I speaking with? Yes, ma'am.
[CUSTOMER][POSITIVE] OK, sure, thank you.
[CUSTOMER][NEUTRAL] My name is [PII]. Last name initial [PII]
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you and [PII], what is a good callback number for you please?
[CUSTOMER][NEUTRAL] [PII] and that's direct.
[AGENT][NEUTRAL] Thank you. And you did say the area code is [PII]?
[CUSTOMER][NEUTRAL] [PII], I beg your pardon.
[AGENT][NEUTRAL] Oh, I'm OK, thank you. And then what is the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes ma'am, it is 023893887.
[AGENT][NEUTRAL] OK thank you one moment while I get the member's information I'll pulled up please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I uploaded it with the uh primary EOB.
[AGENT][NEUTRAL] OK, and any information I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] That you don't need the confirmation number, do you, for the submission of the claim? Would that help? OK, good job. OK.
[AGENT][NEUTRAL] Uh no, ma'am, I don't. No, ma'am, I don't need that.
[AGENT][NEUTRAL] Uh-huh, not necessarily.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for replace Shaw?
[CUSTOMER][NEUTRAL] [PII] for $224.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] Mm. And you said again it's 224, is that correct?
[CUSTOMER][NEUTRAL] Uh, 2, yeah, $224 yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm wait, let me look now let me look at the claim now.
[AGENT][NEUTRAL] I was fixing, and now at this time, I don't see a claim for that billed amount.
[CUSTOMER][NEUTRAL] Uh huh, it's 224 data service 318 2024.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] For 220, yes ma'am.
[AGENT][NEUTRAL] OK, so I did.
[CUSTOMER][NEUTRAL] And you said that confirmation number wouldn't help you?
[AGENT][NEUTRAL] You can give me that, but for the bill amount you're providing for me, I don't have a claim.
[AGENT][NEUTRAL] You can give me
[CUSTOMER][NEUTRAL] OK, it's
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, it's it's OSC.
[CUSTOMER][NEUTRAL] 942-229
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the provider.
[CUSTOMER][NEUTRAL] Um, [PII], the, the rendering provider is [PII], but, uh, we are Carolina Family Care MS.
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] Oh, there we go.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, that OK.
[AGENT][NEUTRAL] Uh, I can't read this morning apparently. Mm, OK.
[CUSTOMER][NEUTRAL] That's all right. Did you have your coffee?
[AGENT][NEGATIVE] I haven't had enough. That's the problem, Lead. I haven't had enough. OK.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][POSITIVE] Oh my gosh.
[CUSTOMER][NEUTRAL] Right, I've been fasting off coffee, um, until [PII] for the past 4 weeks, yeah, uh-huh.
[AGENT][POSITIVE] Oh my goodness.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on this claim, this claim was denied, was Shawn?
[CUSTOMER][NEUTRAL] Mhm, yeah, uh huh and is is it denied for non coverage because Cigna, I was, I was wondering, I think when I spoke with uh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And that must be, I don't know, that must be.
[CUSTOMER][NEUTRAL] What's her name?
[AGENT][NEUTRAL] I don't know, some is that someone with APL? I'm, I'm not familiar with that name.
[CUSTOMER][NEUTRAL] Oh, you know what? Let me tell you, let me tell you, no, no, no, let me tell you what I did.
[CUSTOMER][NEGATIVE] Don't you laugh at me. I said it should have been Cigna and I put [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Uh, yeah, so.
[CUSTOMER][NEGATIVE] they because they denied, yeah, the primary denied for no coverage and I and I submitted it to you guys so you guys denied it as well.
[AGENT][NEUTRAL] Yes, ma'am, because if the primary insurance company does not cover it, then there would not be any benefits on this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, I just needed to have that claim number and that denial. Can you give me the claim number?
[AGENT][NEUTRAL] Yes, it is going to be 357-073-2.
[CUSTOMER][NEUTRAL] Alright, and when did it process that day, right? Uh, [PII]?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Let me get back to the received date.
[AGENT][NEUTRAL] Uh, it was received 227 and processed on [PII].
[CUSTOMER][NEUTRAL] 034 OK [PII].
[AGENT][NEUTRAL] Correct. Mhm. And then, um, the denial remark actually reads on here, Benefits are payable only if your major medical insurance provider provides benefits. If this claim is later paid by the major medical insurance, please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] And you'll reconsider.
[CUSTOMER][NEUTRAL] Oh, OK, and then you guys would reconsider that.
[AGENT][POSITIVE] Yes ma'am, that is great. Now, if you need a copy of this explanation of benefits, [PII], we do have a portal in which you should be able to print it from, and our portal website is located at secured.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] I, I, I actually, uh, have a.
[AGENT][NEUTRAL] Well, yeah, used to file the claim. I was gonna say so.
[CUSTOMER][NEUTRAL] A user OK.
[AGENT][POSITIVE] You did use the OSC to submit it. So, um, yeah, OK, I'm gonna get me some more coffee, [PII], as soon as you and I are done.
[CUSTOMER][NEUTRAL] OK, right.
[CUSTOMER][NEUTRAL] Right, back in uh OK.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Maybe just the pots, maybe just the pots.
[CUSTOMER][NEUTRAL] Tell me.
[CUSTOMER][POSITIVE] It's gonna be uh right right rightit it right there.
[CUSTOMER][POSITIVE] What was your name again? Thank you so much for being so kind.
[AGENT][NEUTRAL] Uh my name is. Oh, you're welcome. My name is [PII] Yes, ma'am. And you're gonna use my name along with today's date as your call reference number.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, thank you so much, [PII] thank you you have a blessed rest of your day, OK?
[AGENT][POSITIVE] I hope you have a blessed day too, and if that's all I can help you with, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][POSITIVE] You're welcome thank you.
[AGENT][POSITIVE] Mm. You're welcome