AccountId: 011433970860
ContactId: bac89e97-c4dc-4a24-b0a3-0c514bc141d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 256619 ms
Total Talk Time (AGENT): 92231 ms
Total Talk Time (CUSTOMER): 86545 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/bac89e97-c4dc-4a24-b0a3-0c514bc141d8_20250324T13:52_UTC.wav
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[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is An[PII]How may I help you?
[CUSTOMER][NEUTRAL] Hi An[PII]my name is Ch[PII]I am calling from Northwest Medical Houghton. I am needing some assistance on a claim, please.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status. And Ch[PII]may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, my telephone number is 52[PII]Policy number is 948876.
[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] It is.
[CUSTOMER][NEUTRAL] I'm going to spell it. It, it's Z [PII].
[CUSTOMER][NEUTRAL] [PII]ast name is H [PII]ate of birth 11[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 for the claim and the total bills?
[CUSTOMER][NEUTRAL] Sure, data service 221 of 25 for $25,609.64.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] All right, so I'm not showing a claim on file um for the member for Fe[PII].
[CUSTOMER][NEUTRAL] It's Fe[PII].
[AGENT][NEUTRAL] You said Fe[PII]I'm sorry, hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No, that's OK. I might have said the se[PII]It's early.
[AGENT][NEUTRAL] It's so it's OK. All right, so I did find it. Hold on one moment.
[AGENT][NEUTRAL] I'm showing the claim was received on Ma[PII].
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] 7180.
[AGENT][NEUTRAL] And on Ma[PII]the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Excepting primary.
[CUSTOMER][NEUTRAL] OK, so what type of policy is this?
[AGENT][NEUTRAL] So this is their Metlink policy. It's a supplemental gap insurance. We pay towards the copay, deductible and co-insurance of covered charges after primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, perfect. And since the claim is already on file once we receive that primary remit, how do we submit it to you? Do we have to submit a new claim or can we just fax the remit?
[AGENT][NEUTRAL] Yeah, you can just, um, you can send it, you can fax it, you can send it electronically or you can mail it. um, as soon as we receive it, we'll go ahead and continue processing.
[CUSTOMER][NEUTRAL] OK, can, it can be fat.
[CUSTOMER][NEUTRAL] I see. Can I get that fax number?
[AGENT][NEUTRAL] Sure, it's 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Paying attention anyone.
[AGENT][NEUTRAL] Um, attention, APL claims department.
[CUSTOMER][POSITIVE] All right. Perfect. Thank you very much for your help today.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today, Ch[PII]?
[CUSTOMER][NEUTRAL] No, that will be all.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a great week.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.