AccountId: 011433970860
ContactId: c764ba41-8879-4960-8cd5-646eb56a6784
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 435309 ms
Total Talk Time (AGENT): 179392 ms
Total Talk Time (CUSTOMER): 90808 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/c764ba41-8879-4960-8cd5-646eb56a6784_20250523T12:50_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello [PII], can I have the first initial to your last name first, please?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] Yes ma'am, my name is [PII] First initial to my last name is [PII].
[AGENT][NEUTRAL] Hi [PII], how may I assist you today?
[CUSTOMER][NEUTRAL] Yes, I was calling to see if you have a secondary claim on file with the primary EOB.
[AGENT][NEUTRAL] OK, I can check the claim for you, and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. May I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes ma'am, let me see here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If
[CUSTOMER][NEUTRAL] Policy number 1912866.
[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] Yes ma'am, just one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And his name is.
[CUSTOMER][NEUTRAL] [PII], first last name, date of birth [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 and the total bills for the claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] $7,718 6,718 dollars 76 cents.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So we have 2 on file. Hold on one second, I'm just getting it together.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the first claim we received said that
[AGENT][NEUTRAL] We need the EOB to see if Major provided anything to the claim, and then the second one, so let me see what documents because this
[AGENT][NEUTRAL] Hold on 1 2nd.
[CUSTOMER][NEUTRAL] It's a secondary claim, so you didn't receive it with the prim UB.
[AGENT][NEUTRAL] Initially, no. Oh well, initially, yes, but it didn't show that uh primary insurance applied anything, so y'all resubmitted it, but I'm trying to see what the outcome was for the second one.
[CUSTOMER][NEUTRAL] Alright, that just give me the claim number once you figure that out.
[AGENT][NEUTRAL] Yes, I'm gonna give you the claim status. Hold on one second.
[AGENT][NEUTRAL] Let me see what was sent in because this was denied asking for the EOB. Do you mind if I place you on just a brief hold? I'm just gonna pull up the documents that were sent in.
[CUSTOMER][POSITIVE] Great, thank you.
[AGENT][NEUTRAL] But the claim number for you is 353-4213.
[CUSTOMER][NEUTRAL] 353-4213
[AGENT][NEUTRAL] 213. Mhm.
[AGENT][NEUTRAL] Let me see what's going on. Hold on one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What happened? Um, let me see if it'll work.
[AGENT][NEGATIVE] No, it's still not working. All right. So let's just do this.
[AGENT][NEUTRAL] 12345678.
[AGENT][NEUTRAL] Um, 213.
[AGENT][NEUTRAL] Do we get 11:22.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, what was the first, what's the first claim number? Because it looks like they're just submitting the 712.
[AGENT][NEUTRAL] 71271209924.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah, some more.
[AGENT][NEUTRAL] No, what was it?
[AGENT][NEUTRAL] 9
[AGENT][NEGATIVE] No, no.
[AGENT][NEUTRAL] 899.
[AGENT][NEUTRAL] OK, hello.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, thank you so much for holding. I apologize for the wait. So I looked through the first claim and the second claim. So the first claim we did receive the explanation of benefits, but it literally has zero for everything except total charges. And then the second one we received is just the claim form. There's no EOB on that one. So that one was denied requesting the EOB.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, let me call Cigna and get the EOB faxed to me and then do you have a fax number?
[AGENT][NEUTRAL] Yes, um, it's [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 [PII].
[CUSTOMER][NEUTRAL] OK. The email address?
[AGENT][NEUTRAL] Um, the mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], and then the zip code is [PII].
[CUSTOMER][NEUTRAL] I fall in to get the secondary to get this back to you.
[AGENT][NEUTRAL] There's
[AGENT][NEUTRAL] There's no timely filing, so, um, once we receive it, we'll go ahead and continue processing.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Alright, well thank you very much. Who is there a reference number for this call?
[AGENT][NEUTRAL] So there's no call reference number. Um, you can use my name in today's date. The first initial again is L like [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, ma'am, that'll be it. Thank you very much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great weekend.