AccountId: 011433970860
ContactId: ba4ecb20-8a59-4349-8ac7-4d8233bb7755
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 327630 ms
Total Talk Time (AGENT): 66511 ms
Total Talk Time (CUSTOMER): 193119 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/ba4ecb20-8a59-4349-8ac7-4d8233bb7755_20250625T15:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], it's [PII] calling from Podesta Hospital. Um, I'm calling because I see that this patient has this insurance, and I just wanted to verify what type of insurance it was and if it was primary or secondary.
[AGENT][NEUTRAL] OK, [PII], I can help you with eligibility. Um, do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, I'm just trying to submit the bill and it's um I'm having an issue. Uh phone number is [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have the policy number for the patient?
[CUSTOMER][NEUTRAL] I do. It's 02203919 M Mary L Lima, the number 7.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, uh, I've got the policy effective [PII]. This is like a secondary gap policy, um, so it'll pick up after his primary processes the claim. Um, do you need the benefits for it?
[CUSTOMER][NEUTRAL] Um, I called, I call, um, actually.
[CUSTOMER][NEUTRAL] Yeah, is there a way that um
[CUSTOMER][NEUTRAL] You could send me like, like fax me the benefits that says it's a.
[CUSTOMER][NEUTRAL] It's uh a gap policy.
[CUSTOMER][NEUTRAL] Because the primary is denying our claims, saying that they have another insurance primary. So.
[AGENT][NEUTRAL] Oh, OK. Um,
[CUSTOMER][NEUTRAL] I'm trying to, um, yeah, I'm trying to see if I can do something without involve like getting the pay. It's always hard to get the patient to jump in and stuff. And since it is a gap policy, I think that would be enough to, like, obviously, it's a, it would be a secondary. There's not really. If I could just get past the coordination of benefits cause this claim is from February to, to March.
[AGENT][NEUTRAL] OK, so we have to have the primary EOB before we can even process the claim. So has it been processed by the primary?
[CUSTOMER][NEGATIVE] No, no, no.
[CUSTOMER][NEUTRAL] No, that's what I'm trying to say, the primary is denying the claim.
[CUSTOMER][NEGATIVE] They're denying it because they're saying they are not the primary. They're saying someone else's. And, and that looks like um they, they do this all the time. If they know about you guys, they're just gonna deny it and say you guys are primary, so I need to, I need something, either the patient to call and fix that or since you're telling me it's a gap, is there a way you could fax me the benefits so I could forward it to their primary?
[CUSTOMER][NEUTRAL] And let them that way they could advise their primary you know you're the primary they're the gap.
[AGENT][NEUTRAL] Um, uh, well, we don't usually fax benefits, um, let me see.
[AGENT][NEUTRAL] Uh, do you have the patient's card?
[CUSTOMER][NEUTRAL] Mm let me see.
[CUSTOMER][NEUTRAL] Let me see if I do.
[CUSTOMER][NEUTRAL] Give me 1 2nd here.
[AGENT][NEUTRAL] Just Cigna's primary.
[CUSTOMER][NEGATIVE] Right, but the way, yeah, but they, they could deny the claim if they find out the patient has any other insurance. It doesn't even have to make sense to them. They just go denied.
[CUSTOMER][NEUTRAL] Do you see what I'm saying? And then they just like forced the patient to have to call in.
[CUSTOMER][NEUTRAL] But since this is a gap, it should be pretty self-explanatory. There's really nothing to coordinate cause gap is gap.
[CUSTOMER][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] Let me see if I have it, maybe.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] The counter.
[AGENT][NEUTRAL] I could send you a copy of the card. It says this is not a major medical plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me, let me see if I have the card really quickly.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Come on, come on, come on, come on, come on, and.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Doesn't look like we even have the card, so no. Would you, would you be so kind to fax it to me? I'm sorry. Or you can email it, whatever is easier.
[AGENT][NEUTRAL] Yeah, it was
[AGENT][NEUTRAL] Uh, what's your effects?
[CUSTOMER][NEUTRAL] OK. Fax number is um 786.
[CUSTOMER][NEUTRAL] 533.
[CUSTOMER][NEUTRAL] 926-4, attention, [PII].
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah, on there it says this is not a major medical plan. This is a supplemental limited benefit plan on the card. That's what uh it states so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, that works.
[AGENT][NEUTRAL] OK, I'll, I'll get that faxed over. Uh, it just takes a few minutes. Is there anything else I can help with?
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Um, uh, no, I think we are all set.
[AGENT][POSITIVE] OK, well thanks for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] Thank you I appreciate it. Have a great day as well bye bye.