AccountId: 011433970860
ContactId: b76bc4fb-43ee-4743-bdc5-0919ea3186c1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 451820 ms
Total Talk Time (AGENT): 102970 ms
Total Talk Time (CUSTOMER): 184725 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/b76bc4fb-43ee-4743-bdc5-0919ea3186c1_20250604T18:56_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. My name is [PII] calling from provider's office checking on our claim status.
[AGENT][NEUTRAL] OK, [PII], I'm happy to check on a claim. What's the policy number?
[CUSTOMER][NEUTRAL] on Monday
[CUSTOMER][NEUTRAL] Policy number.
[CUSTOMER][NEUTRAL] 02446538.
[CUSTOMER][NEUTRAL] OK, just be a box.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] payment and date.
[CUSTOMER][NEUTRAL] Add Red. Date of birth, [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $557 even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] 03
[CUSTOMER][NEUTRAL] Yeah 23319 New York 100.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] So it looks like we did receive a claim on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim was processed and denied [PII].
[CUSTOMER][NEUTRAL] 25.
[AGENT][NEUTRAL] Benefits are only payable if their major medical pays.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's medical page.
[CUSTOMER][NEUTRAL] Uh, could you please explain uh what we need to submit to process the claim.
[AGENT][NEUTRAL] If the insured's primary paid for this state of service, then we need the explanation of benefits showing that.
[AGENT][NEUTRAL] Or the secondary, so it's only gonna pick up if the major medical paid.
[CUSTOMER][NEUTRAL] And if it's showing that
[CUSTOMER][NEUTRAL] We're the
[CUSTOMER][NEGATIVE] That medical a pain.
[CUSTOMER][NEUTRAL] Uh, we already submitted a primary EUB.
[CUSTOMER][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Well, this claim was received on [PII].
[CUSTOMER][NEUTRAL] Again, we submitted on [PII]. On [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, ma'am. I mean, we submitted on [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] They just.
[AGENT][NEUTRAL] OK, so I did double check the information submitted on [PII]. There is no explanation of benefits from the insured's primary.
[CUSTOMER][POSITIVE] One right right getting another then let's put that one today.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Let me check with the clearing house.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And a claim from box number 64.
[CUSTOMER][NEUTRAL] Uh, we mentioned of the claim number and we attached.
[CUSTOMER][NEUTRAL] We attached the primary EOB.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] But I'm not, uh, when I'm not.
[AGENT][NEUTRAL] OK, so it shows that the charges were 557 and 557 was not covered. So if the insured's major medical did not pay anything, then we will not pay anything.
[CUSTOMER][NEUTRAL] And 57 was not.
[CUSTOMER][NEUTRAL] OK, then you received the primary UB right?
[CUSTOMER][NEUTRAL] No
[AGENT][NEGATIVE] I see where it says the charge amount and nothing was paid. I don't, it doesn't look like a primary EOB to me, but I do see that.
[CUSTOMER][NEUTRAL] but I do see that.
[CUSTOMER][NEUTRAL] OK. Primary is not pay the amount. So, secondly also will not pay the amount, right?
[AGENT][NEUTRAL] Right, we only pay if the primary pays.
[CUSTOMER][NEUTRAL] It's the primary case.
[CUSTOMER][NEUTRAL] OK, give me a minute.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For this one, we can uh bill the patient, right?
[AGENT][NEUTRAL] We are not able to advise on patient responsibility, that would be up to the facility or provider.
[CUSTOMER][NEUTRAL] OK, is this possible to send the denied EOP through fax?
[AGENT][NEUTRAL] What's the fax number?
[CUSTOMER][NEUTRAL] What's the fax number? 854
[CUSTOMER][NEUTRAL] 999-4535. Attention to [PII]
[AGENT][NEUTRAL] OK, I'm sending that now. Give it about 5 minutes to come through.
[CUSTOMER][NEUTRAL] OK, could you please spell your name for a documentation office.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] But,
[CUSTOMER][NEUTRAL] Call reference number?
[AGENT][NEUTRAL] Is my name on today's date?
[CUSTOMER][POSITIVE] My name, what's today's date? Thank you so much. Have a great day. Bye-bye. Take care.
[AGENT][NEUTRAL] Mhm