AccountId: 011433970860
ContactId: b1ceb268-b8b1-478a-b834-ebffdaf68750
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 376279 ms
Total Talk Time (AGENT): 161041 ms
Total Talk Time (CUSTOMER): 98878 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/b1ceb268-b8b1-478a-b834-ebffdaf68750_20250115T21:50_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling to check on a claim status from provider's office.
[AGENT][POSITIVE] OK, I'll be more than happy to assist you with the claim status, [PII]. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Just one.
[AGENT][NEUTRAL] Alright, and may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. The callback number is going to be [PII].
[CUSTOMER][NEUTRAL] And my extension is [PII].
[AGENT][POSITIVE] Thank you for that and the member's policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Sure. That will be 01462912.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] That's going to be uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] Sure, that is [PII] and the total bill is $49,910.69.
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] That's going to be Oklahoma Specialty Surgery.
[AGENT][NEUTRAL] OK, and are you wanting the original claim or the, the second claim that came in? Well, it's denied as a duplicate. Which one would you prefer?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] I'm checking on the 2nd claim which has been denied as a duplicate.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I'm sure we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that claim number is 353.
[AGENT][NEUTRAL] 5085.
[AGENT][NEUTRAL] And on [PII], the claim was denied as a duplicate, which it was originally denied requesting the explanation of benefits from primary insurance. So let me see what was received. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] So we received 3 pages. The first page is the claim form, the 2nd and 3rd page is the itemized bill. We're requesting the explanation of benefits from their primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] One moment, let me confirm you that um.
[CUSTOMER][NEUTRAL] OK. So, they have contacted the patient and they informed that uh you are the primary insurance of the member and the A9 secondary one because we have initially submitted to Aetna and they have also denied the same uh denied as you.
[AGENT][NEUTRAL] Hold on 1 2nd.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm, yeah.
[AGENT][NEUTRAL] OK, so this policy is second to their Blue Cross Blue Shield policy only. We're not second to Aetna. This is a group um policy through their employer. So the major medical is Blue Cross Blue Shield, and we are second to that policy.
[CUSTOMER][NEUTRAL] OK, did you have the member ID of Blue Cross Blue Shield?
[AGENT][NEGATIVE] Unfortunately, I don't. It only shows the name of the major medical. I don't have like any policy information or ID.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So did you send any letter to the member?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Did you send any letter or correspondence to the member uh regarding this information?
[AGENT][NEUTRAL] Let me see if there was an explanation, I mean, you mean like an explanation of benefits?
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] Yes, the explanation of benefits was sent to the member on [PII].
[CUSTOMER][NEUTRAL] OK. One moment, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so we don't receive your EOB as of now, so can you please uh send me a copy of the DOB?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] That is [PII] with attention to my name.
[AGENT][NEUTRAL] OK, that's [PII]?
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, so I'm faxing over the provider explanation of benefits for you now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] No, that's all. That's, uh, can I get the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date and um that's [PII] is [PII].
[CUSTOMER][POSITIVE] OK. Thank you, uh, that's all I needed.
[AGENT][POSITIVE] You're very welcome, [PII]. Well, thanks for calling APL and I hope you have a good day. OK.
[CUSTOMER][POSITIVE] Yeah, I'm sorry.
[CUSTOMER][NEUTRAL] Sorry, sorry. Um, can I get the original claim number?
[AGENT][NEUTRAL] 353.
[AGENT][NEUTRAL] 1819.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.