AccountId: 011433970860
ContactId: cc10d347-47b9-42e9-9538-28ee000e1321
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 448769 ms
Total Talk Time (AGENT): 185877 ms
Total Talk Time (CUSTOMER): 95257 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/cc10d347-47b9-42e9-9538-28ee000e1321_20250128T14:36_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. Initial of my last name is [PII] calling from provider office looking for claim status.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with the claim status today and.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Do you mind rushing if I get a good call back number?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you and then what is that member's policy number today?
[CUSTOMER][NEUTRAL] 01813065 M as in Mary, L as in Lima, 8.
[AGENT][POSITIVE] Perfect and give me just a moment to get that pulled up for you my friend.
[AGENT][POSITIVE] Are you having a great day so far?
[CUSTOMER][NEUTRAL] Uh yes. And how about you?
[AGENT][POSITIVE] Oh, I'm doing great. Thank you so much for asking.
[CUSTOMER][POSITIVE] Thank you for asking.
[AGENT][NEUTRAL] Alright, and just one more second, I'll have that pulled up. Sorry, it's a little slow this morning.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] All righty. I think I have your insured pulled up. Would you mind verifying their first and last name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Yes, first name is [PII]. Last name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Perfect and I do see her here and for Ms. [PII], what is the date of service we're looking at?
[CUSTOMER][NEUTRAL] D of service is [PII].
[AGENT][POSITIVE] Perfect and then the bill amount?
[CUSTOMER][NEUTRAL] $513 even.
[AGENT][POSITIVE] Alright, give me just a little bit of time. I'll find that for you.
[CUSTOMER][POSITIVE] OK. Take your time.
[AGENT][NEGATIVE] So unfortunately, I'm not showing.
[AGENT][NEUTRAL] Any
[AGENT][NEUTRAL] Hold on, let me try something else. Hang tight with me one second.
[AGENT][NEUTRAL] That's why.
[AGENT][NEUTRAL] All right, it looks like your insured actually has an updated policy number that fell under. Is that something you'd like to have on file for yourself?
[CUSTOMER][NEUTRAL] And as per our end there's no information about, about that.
[AGENT][POSITIVE] OK, no worries.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] 612 I was able to find your claim though. I see that we and then if you could verify for me please uh real quick sir just the name of this facility on file for the claim.
[CUSTOMER][NEUTRAL] Murray Olycology and retina INC.
[AGENT][POSITIVE] Wonderful thank you so much. So I see that we received your claim on [PII]. we processed it on [PII], and I show your claim number listed is 3542612.
[AGENT][NEGATIVE] And I do show that that claim denied.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] So it says on here that.
[AGENT][NEUTRAL] The policy states that other medical plan means any basic major medical comprehensive medical or managed care policy provided through the policyholder through which a covered person has coverage. The term other medical plan does not include Tricare, Medicare, Medicaid. Therefore, no benefits will be provided for these services.
[CUSTOMER][NEUTRAL] OK. Uh, can, can you summarize this for me? Uh, if the American public life is not secondary insurance for the member now and the other insurance covered these services, is it the denial?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] So yeah it's denied because we are only secondary to the major medical from the same subscriber from their same employer so if.
[AGENT][NEUTRAL] So if they use another insurance that isn't that particular major medical plan that they had with their employer, this policy does not cover it.
[CUSTOMER][NEUTRAL] Uh, but the primary insurance is United Healthcare.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me see what I do.
[CUSTOMER][NEUTRAL] Yes. Previously, United Healthcare paid the claim and then cross over to the American Public Life, and the American Public Life paid the claims.
[AGENT][NEUTRAL] So it looks like what you sent us was something from Medicare in that claim.
[AGENT][NEUTRAL] So it says Medicare remittance. I'm not showing anything from their major medical United Healthcare.
[CUSTOMER][NEUTRAL] OK. So we had to resubmit this claim with the primary UB of United Healthcare.
[AGENT][POSITIVE] Um, yeah, you certainly can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. May I have the call reference number?
[AGENT][NEUTRAL] Uh yes, absolutely. The call reference number is just my name [PII].
[AGENT][NEUTRAL] And then today's date, sir?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Uh, OK, LA. Thank you so much. Have a wonderful rest of your day. Stay safe. Bye for now.
[AGENT][POSITIVE] Oh, my pleasure. Thank you. You too. Bye bye.