AccountId: 011433970860
ContactId: cd88828d-215b-49ac-b405-50df70228115
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 278320 ms
Total Talk Time (AGENT): 121026 ms
Total Talk Time (CUSTOMER): 93544 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/cd88828d-215b-49ac-b405-50df70228115_20250501T16:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, um, I'm calling regarding a claim that I submitted, um, I think it's about 2 weeks ago or so, um, I submitted it online and initially I got a denial and it just asked me for more information and I did submit the additional information, but then that claim was denied saying it was a duplicate so I'm not sure what's going on. I wanna just check the status of the first one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Sure, OK, yeah, I can check that out for you. um, what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you. And then do you have your policy number?
[CUSTOMER][POSITIVE] Yes, I do. Are you ready?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 0204
[CUSTOMER][NEUTRAL] 751 M as in Mary, I'm sorry, 7514 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] OK, bear with me just a moment. I'm just gonna verify some information really quick. Uh, [PII], can I get your date of birth please?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address we've got on file for you. uh, looks like it's a [PII] account.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] OK, thank you so much for verifying all of that. OK, bear with me just a moment, let me take a look here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I did see the original claim. Um, does look like we were missing out of my statement with the diagnosis code and a copy of the primary EOB um well the EOB from your primary insurance. Um, so this most recent submission, that's the information that you sent us.
[CUSTOMER][NEGATIVE] Um, I didn't submit the primary, the EOB from my primary insurance because they don't take that insurance, so it couldn't even be submitted.
[AGENT][NEUTRAL] OK, so, um, the, well, first that would be why it registered as a duplicate since we didn't get all of the information we needed, but I will say that is how this policy works, [PII], your major medical or whoever you have as your primary, they do have to be able to contribute something to um whatever treatment you're receiving for this policy to pay anything. This policy can't be used instead since it's secondary medical.
[CUSTOMER][POSITIVE] But I think I'm better now. Can you repeat that?
[AGENT][NEUTRAL] Oh sorry, did you not hear what I said?
[CUSTOMER][NEUTRAL] Yeah, no, I didn't hear it, but I have service now, so you said that the way this policy.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yes, OK, so as this is a secondary medical policy, your it is dependent on your primary insurance. So if they don't pay for a service or a treatment, anything like that, this policy can't. That's why we need a copy of the primary EOB for claims because we do have to see that they've contributed something for this policy to pay.
[CUSTOMER][NEGATIVE] So if this provider doesn't even take that insurance, I can't submit it to you guys?
[AGENT][NEGATIVE] Correct, your primary insurance has to be able to pay for this policy too. This policy can't be used instead.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK. All right, well, I guess that answers the question then. All right, thank you.
[AGENT][POSITIVE] Got you, sorry about the confusion. Sure, did you have any other questions for me?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Um, no, that's it. Thank you. Bye bye.
[AGENT][POSITIVE] All right, yeah, thanks for giving us a call. Have a great rest of your day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thanks bye bye