AccountId: 011433970860
ContactId: b0ad220b-55fe-4e28-a4a7-251fcfbdcf87
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 341600 ms
Total Talk Time (AGENT): 115202 ms
Total Talk Time (CUSTOMER): 146608 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/b0ad220b-55fe-4e28-a4a7-251fcfbdcf87_20250618T21:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from um Lore Imagined, and I was wondering if you could help me out with a claim that we had sent in for a patient that was denied.
[AGENT][NEUTRAL] OK. And where did you say you're calling from, [PII]?
[CUSTOMER][NEUTRAL] Life reimagine the office of [PII].
[AGENT][NEUTRAL] And can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Absolutely it's [PII].
[AGENT][NEUTRAL] And what's the policy number of the patient?
[CUSTOMER][NEUTRAL] OK, the policy number is going to be.
[CUSTOMER][NEUTRAL] 02319970
[AGENT][NEUTRAL] OK, give me just a moment to look that up.
[CUSTOMER][NEUTRAL] And I do have an explanation of benefits that shows the denial. What I'm trying to understand it says that the policy does not cover office visits, so I just wanna make sure that.
[CUSTOMER][POSITIVE] That's correct and.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] We should have been filing somewhere else.
[AGENT][NEUTRAL] OK, um, uh, can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Uh, yes, hold just one moment.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have the claim number with you?
[CUSTOMER][NEUTRAL] Uh yeah, hold on, let me see if I can, there's a reference number. There's a claim number, yes, so 3414029.
[AGENT][NEUTRAL] All right, let me check.
[CUSTOMER][NEUTRAL] It looks like it didn't like apply toward a deductible coinsurance or anything. It just says, uh, simply that office visits are not covered by the above numbered policy, so I'm just wondering what type of plan she has. Is this something that.
[AGENT][NEUTRAL] Right. And this is secondary gap. Yes, uh, this is secondary gap insurance. Um, would this be an inpatient or outpatient? Mhm.
[CUSTOMER][NEUTRAL] And we cover certain things.
[CUSTOMER][NEUTRAL] Oh it is OK.
[CUSTOMER][NEUTRAL] It's outpatient, so you're saying she has a primary?
[AGENT][NEUTRAL] Um, yes, she would need a primary.
[CUSTOMER][NEUTRAL] Insurance
[AGENT][NEUTRAL] She would need a primary to have this.
[CUSTOMER][POSITIVE] Oh great.
[AGENT][NEUTRAL] You need me to, I I don't have I can't give you the member ID number because I don't have it, but I can give you the um who they have their primary with.
[CUSTOMER][NEUTRAL] Lord
[CUSTOMER][POSITIVE] Uh, yeah, if you could just tell me who that it's with, I can get everything else.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Because she didn't tell us that she had a primary. This is all that she gave us.
[CUSTOMER][NEUTRAL] That's probably why you
[CUSTOMER][NEGATIVE] Maybe why it didn't process correctly because it wasn't filed with the primary first.
[AGENT][NEUTRAL] So it looks like their primary medical insurance is United Healthcare.
[CUSTOMER][POSITIVE] Goodness gracious.
[AGENT][NEUTRAL] And it does show on her policy that office visits aren't um
[AGENT][NEUTRAL] Aren't covered. However, if she has treatment in an office, the treatment part is, is covered, but not the office visit itself. However, um, their primary might pick that up. Um, I, I guess you just didn't know that they had a primary insurance, but yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] No, she did not tell us that she had a primary insurance. I'm looking everywhere in here and there's nothing. She actually gave us this card like several times and somebody from the office has scanned it in like multiple times but.
[CUSTOMER][NEUTRAL] I didn't take her primary.
[AGENT][NEUTRAL] Yeah, it's United Healthcare. Yeah, it's United Healthcare.
[CUSTOMER][NEUTRAL] Expiration.
[AGENT][NEUTRAL] Well, sometimes when they, when they buy since this is supplemental, it's OK. Sometimes when they get it through supplemental, um, I, I don't think that we always send a card out or, and so they might just assume that the, it's tied to their, their major medical and it's not. It just depends. That's just an assumption, but it's probably just the only card she had with her.
[CUSTOMER][POSITIVE] I'm so sorry.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, um, and.
[CUSTOMER][NEUTRAL] Um, the other thing, so, so even if we were to say we did file this with and, and we are going to send it to United Healthcare Primary, um, this secondary doesn't pick it up, is that correct? Is that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, right, because it was an office visit, that's not a, that's not a um covered service on this policy.
[CUSTOMER][NEUTRAL] OK, so she, so she will owe any remainder like of her primary, right? That's after her primary processes.
[AGENT][NEUTRAL] Uh, we don't
[AGENT][NEUTRAL] We don't determine patient responsibility that would be up to to you and her primary.
[CUSTOMER][POSITIVE] OK perfect OK thank you so much this is very helpful.
[AGENT][POSITIVE] You're welcome, you're welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, no, dear, that's all I needed.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] You too thank you so much.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Bye.