AccountId: 011433970860
ContactId: c3ea0819-e7a5-4970-a8fc-e56ef1982415
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 299119 ms
Total Talk Time (AGENT): 76817 ms
Total Talk Time (CUSTOMER): 185100 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/c3ea0819-e7a5-4970-a8fc-e56ef1982415_20250513T13:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. My name is [PII] and I'm calling for Dell Children's Medical Group to check on additional information about a claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes. I have already checked with you. We just need some additional information about the claim.
[AGENT][NEUTRAL] OK, [PII], I'm happy to check on a claim for you today. Do we have the patient's policy number or claim number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh yes, the patient's policy.
[CUSTOMER][NEUTRAL] Number is 1967205.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, date of birth is [PII], name [PII].
[AGENT][POSITIVE] Thank you, data service.
[CUSTOMER][NEUTRAL] Is uh [PII] for $569 even and um sir I do have a specific question once you have the claim.
[AGENT][NEUTRAL] Alright, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then A for documentation, do you have a good callback number?
[CUSTOMER][NEUTRAL] Um, sure. You could use uh [PII]. That's a direct line.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, so I have that claim pulled up. How uh what specific question did you have today?
[CUSTOMER][NEUTRAL] Uh, well, I see that the office visit is not covered, and, uh, you know, it says we need to update, let me see. It says please provide copies of your updated explanation, uh, which I am not sure, uh, exactly what that means. So, is this actually non-covered or, uh, are you guys asking for extra information on the claim? That's what I'm confused about.
[AGENT][NEUTRAL] OK, so office visits are not covered under the member's policy. We are the members secondary insurance, so we need the explanation of benefits from their primary to process the remaining portion of the claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, got it. Now, uh, you said you guys are secondary. Could you tell me who's primary according to you and when was that updated?
[AGENT][NEUTRAL] We do not have that information. You would have to check with the insured.
[CUSTOMER][NEUTRAL] Got it. So you don't know whether, uh, you, but you're sure that you guys are showing secondary, not primary, because according to me, this particular claim was billed as primary to you guys directly.
[AGENT][NEUTRAL] Yes, this member's plan is a supplemental plan. It's not a major medical.
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] Oh, OK, got it. Uh, got it. OK, OK, thank you. Uh, I'll go ahead and, uh, quickly make a note of that here, and, uh, you don't have any information about the time the insurance at all, right? Nothing.
[AGENT][POSITIVE] Correct, correct.
[CUSTOMER][NEUTRAL] OK, uh, do you know when was this COB, I mean the coordination of benefits updated by the member with you guys? Any idea?
[AGENT][NEGATIVE] There is no coordination of benefits.
[CUSTOMER][NEUTRAL] No. OK. Got it. So,
[CUSTOMER][NEUTRAL] Let me quickly go ahead and.
[CUSTOMER][NEUTRAL] Let me make a note of that here.
[CUSTOMER][NEUTRAL] Alright, I will go ahead. However, uh, you did say that the office visits, I mean, the office visits are not covered under this member's plan. So even if I build this, uh, to you as secondary, it will still be not denying as non-governed, right, because of the office.
[AGENT][NEUTRAL] The office, the office visit portion, yes, would be correct.
[CUSTOMER][NEUTRAL] Alright, I just need to document that office was it not.
[CUSTOMER][NEUTRAL] Uh, and the, you said the member has this uh supplement plan, right?
[AGENT][NEUTRAL] This is the supplemental secondary, yes.
[CUSTOMER][NEUTRAL] OK, supplemental secondary plan.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right, perfect. I will go ahead and make a note of that here. Thank you so much for all your help, sir. Truly appreciate it. And uh could I get a reference number for today's call?
[AGENT][NEUTRAL] Yeah, absolutely. Call reference is my name with my last initial and then today's date. My name again is [PII], that's [PII] Last initial [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I give you
[CUSTOMER][POSITIVE] Got it. Thank you for all your help and you have a wonderful day ahead. Bye-bye.
[AGENT][NEUTRAL] You, you too, bye bye.