AccountId: 011433970860
ContactId: b3749b3f-12ab-4511-977c-5cdcfa17cb2b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 465829 ms
Total Talk Time (AGENT): 205560 ms
Total Talk Time (CUSTOMER): 171429 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/b3749b3f-12ab-4511-977c-5cdcfa17cb2b_20250609T19:44_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I have a question about a claim.
[AGENT][NEUTRAL] OK, are you with the provider or is it for yourself?
[CUSTOMER][NEUTRAL] Um, it's for myself.
[AGENT][NEUTRAL] OK. Do you have your policy number?
[CUSTOMER][NEUTRAL] I do, um, it's 247-581-9.
[AGENT][NEUTRAL] OK. Could I get your name and your date of birth?
[CUSTOMER][NEUTRAL] Sure, [PII], [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Can you verify your address and your email address?
[CUSTOMER][NEUTRAL] Um, [PII], and it's [PII].
[AGENT][POSITIVE] OK, thank you. And then lastly, a good callback number in case we're disconnected.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, thank you. And then what claim can I help you with?
[CUSTOMER][NEUTRAL] Let's
[CUSTOMER][NEUTRAL] Um, so this is with claim number 3606859.
[AGENT][NEUTRAL] OK, let me get that pulled up.
[AGENT][NEUTRAL] OK, yes, I see that it looks like we were waiting on our primary explanation of benefits.
[AGENT][NEUTRAL] Let me see if we received
[CUSTOMER][NEUTRAL] Um, yeah, so is that something from me or is it something you're getting from the insurance company?
[AGENT][NEUTRAL] Uh, let's see it.
[AGENT][NEUTRAL] Did you submit the claim or was this submitted by your provider?
[CUSTOMER][NEUTRAL] It would have been submitted by the provider.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the provider would uh provide that information we send a notice to them saying that we need that information and then the provider should send it back to us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got you. Cause yeah, I've had instances before where it was asking me to provide copies of the explanation and so I would just go on to my um my insurance app and I could download it and upload it, but um
[CUSTOMER][NEGATIVE] I don't, when I go on to my um my [PII] app, I don't even see anything that is um because I think this one was for $138 and I don't see a claim.
[CUSTOMER][NEUTRAL] Um, on my on my primary insurance for that amount. So I didn't know what to send you.
[AGENT][NEUTRAL] Oh, OK, yeah.
[CUSTOMER][NEUTRAL] Or could it be for a line item?
[CUSTOMER][NEUTRAL] On a bill or something?
[AGENT][NEUTRAL] Uh, yeah, it looks like it's for $138 for associated physicians, MCV associated physicians.
[AGENT][NEUTRAL] [PII] was the date.
[CUSTOMER][NEUTRAL] Yeah, and, and when I
[CUSTOMER][NEUTRAL] I can see all the MCV um claims, but there's none for $138.
[AGENT][NEUTRAL] OK, um, let me see what they submitted just to make sure.
[AGENT][NEUTRAL] Usually they're pretty good about responding back and getting that to us. Um, let me make sure what we've received.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah, they just build that one specific um amount.
[CUSTOMER][NEUTRAL] Yeah, just
[AGENT][NEUTRAL] Looks like that's all they build.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK. Maybe that's not showing up on my primary insurance app yet, um.
[CUSTOMER][NEUTRAL] Because yeah unless they're or would they have added two claims together.
[AGENT][NEUTRAL] No, normally they'll just do it all at once. Um, I probably, what I'd do is probably give your physician a call and tell them that you don't show this process by your primary yet and if they could resubmit to your primary insurance.
[AGENT][NEUTRAL] That way that gets done and then we have once once that's completed, we'll be able to process the claim with the provider sending that to us.
[CUSTOMER][NEUTRAL] OK, and so but the I like I don't even have a claim. Do you have a claim number from the primary insurance that I can give them because.
[AGENT][NEUTRAL] I don't.
[AGENT][NEUTRAL] Yeah, I don't
[CUSTOMER][NEUTRAL] I don't know what to tell them to look for.
[AGENT][NEUTRAL] Yeah, I don't have anything from the primary insurance. You say it was with, who'd you say Cigna?
[CUSTOMER][NEUTRAL] Um, no, um, Blue Cross Blue Shield. Sydney is the app, but.
[AGENT][NEUTRAL] OK, Blue Cross Blues
[AGENT][NEUTRAL] OK. Um, I don't have a claim number from Blue Cross Blue Shield. All I've got is the actual claim from Doctor [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So it's just the actual just the claim for the charges don't have any reference to a Blue Cross Blue Shield claim number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so I guess if I just.
[CUSTOMER][NEUTRAL] Oh, do you know, sorry, do you know what I should like tell them to help them identify it? Because if it's not showing up in my account I don't know what would show up in there.
[AGENT][NEUTRAL] Well, the, the doctor, let, let me make sure we haven't, we haven't sent it. Maybe they have. Let me see. Just making sure.
[CUSTOMER][NEUTRAL] On their end.
[AGENT][NEUTRAL] No, that's just another claim. OK. Um, so the doctor's office would be the one that needs to send the claim to Blue Cross Blue Shield. So you would call Doctor [PII] and say, I, I don't show Blue Cross Blue Shield has received this claim for 4/14.
[AGENT][NEUTRAL] For $138 can they resend it to Blue Cross Blue Shield?
[CUSTOMER][NEGATIVE] Or that you haven't received it, not Blue Cross.
[CUSTOMER][NEGATIVE] Blue Shield hasn't received it, right?
[AGENT][NEUTRAL] I, I don't know has Blue Cross, I thought you'd stated that you don't see the explanation of benefits from online from on Blue Cross Blue Shield, is that right?
[CUSTOMER][MIXED] Correct, but doesn't Blue Cross Blue Shield pay and then they send whatever they don't pay to you? Or am I misunderstanding?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Well, normally how it works is, so if your charges were $138 that day, Blue Cross receives that claim for $138. They pay if there's $20 left over, they'll usually submit the entire claim to us with the primary EOB from Blue Cross Blue Shield. We'll see that there's just $20 left and then we pay that $20. Does that make sense?
[CUSTOMER][NEUTRAL] Yeah, I just, I'm not clear on um.
[CUSTOMER][NEGATIVE] What to tell them that they're gonna see as 138 because there's nothing on my primary insurance showing up for 138.
[CUSTOMER][NEUTRAL] So I don't know why you would have gotten it but they didn't. Does that make sense?
[AGENT][NEUTRAL] Yeah, um,
[AGENT][NEUTRAL] The provider, Doctor [PII] sent this to us. So yeah, I'm not sure.
[AGENT][NEGATIVE] Why they haven't sent it to Blue Cross.
[CUSTOMER][NEGATIVE] Like they wouldn't have sent it to you.
[CUSTOMER][NEUTRAL] Without sending it to Blue Cross, right? Or is that what happened?
[AGENT][NEGATIVE] It looks like that's what happened, yeah, that they sent it to us. Maybe they sent it to us in error and meant to send it to Blue Cross.
[AGENT][POSITIVE] Um, that absolutely.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] That definitely could have happened, um, if maybe they, like I said, sent it here first by mistake and didn't send it to Blue Cross by accident, so.
[CUSTOMER][POSITIVE] Got you. OK, I will call and see if they can figure it out. All right, thank you.
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] OK, thanks for calling [PII]. I hope you have a good afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.