AccountId: 011433970860
ContactId: bf8d18d8-3d00-4e34-bb51-2b0cb4a1c62b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 276299 ms
Total Talk Time (AGENT): 130968 ms
Total Talk Time (CUSTOMER): 49564 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/bf8d18d8-3d00-4e34-bb51-2b0cb4a1c62b_20250429T19:12_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling for claim status.
[AGENT][NEUTRAL] OK [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And how many points do you have to check status on today?
[CUSTOMER][NEUTRAL] Just one
[AGENT][NEUTRAL] OK, and what is that member's policy number, please?
[CUSTOMER][NEUTRAL] 02510689 ML 8.
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Date of service is [PII]. Bills amount is $1,906.96.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do see that this claim was received and it was received on [PII].
[AGENT][NEGATIVE] And it was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 0466.
[AGENT][NEUTRAL] And the reason for the denial on this claim.
[AGENT][NEUTRAL] It's going to be.
[AGENT][NEUTRAL] Benefits are payable only if the major medical insurance provider provides benefits. If this claim is later paid by the major medical insurance, please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] OK. Does that mean they need the EOB from the primary insurance?
[AGENT][NEUTRAL] Yes, ma'am. Mhm, because this is a supplemental policy, we will always have to have the primary insurance, EOB along with the claim for reviews.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And how should I send that by mail?
[AGENT][NEUTRAL] It can be mailed, it can be faxed.
[CUSTOMER][NEUTRAL] OK. Um, what is your fax number, please?
[AGENT][NEUTRAL] OK, so the fax number is [PII].
[AGENT][NEUTRAL] [PII] attention claims.
[AGENT][NEUTRAL] And then once if you need a copy of this explanation of benefits with that claim number on it um you can actually you should be able to print that LA from our portal by going to secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Thank you so much. Do you have a reference number?
[AGENT][POSITIVE] Well, you are very welcome. Yes, ma'am. You would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] All right. Thank you.
[AGENT][POSITIVE] Well, you're welcome and thank you for calling APL. I hope you have a very nice rest of your day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.