AccountId: 011433970860
ContactId: ce4fe69f-81f9-4873-b4bd-5ceabec223f9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 308869 ms
Total Talk Time (AGENT): 99937 ms
Total Talk Time (CUSTOMER): 172007 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/ce4fe69f-81f9-4873-b4bd-5ceabec223f9_20250527T19:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh, hey, this is [PII] from provider's office. Uh, this is American Public Life.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And what's the name you said?
[AGENT][NEUTRAL] Uh, my name is [PII]
[CUSTOMER][NEUTRAL] Yeah. It's [PII].
[AGENT][NEUTRAL] Yes. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][MIXED] OK, got it. Thank you so much. I appreciate it. Uh, I just, uh, I just want to know about, we have a denial here and, you know, uh,
[CUSTOMER][NEUTRAL] You want the basic detail?
[AGENT][NEUTRAL] We're, we just needing uh.
[CUSTOMER][NEUTRAL] Like I have a question on the time.
[AGENT][NEUTRAL] OK, so clarification regarding that denial, is that correct?
[CUSTOMER][POSITIVE] Yeah, yeah, that's, that's correct.
[AGENT][NEUTRAL] OK, yes, I could take a look at that for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. That is [PII], it's in direct line.
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, that is.
[CUSTOMER][NEUTRAL] 01677458 M as in Mike, L as in Lima.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] OK. The patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that uh do you have that claim number?
[CUSTOMER][NEUTRAL] Mm, yeah, I do have. It's 3530.
[CUSTOMER][NEUTRAL] 109.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Uh, so what happened was it was denied for a primary EOB and we were submitting the primary EUB again and again. And one of our colleagues called in April and he spoke to
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. OK. It's [PII] He spoke to that person, uh.
[CUSTOMER][NEUTRAL] On your side, and she sent the claim back for a review or something.
[CUSTOMER][NEUTRAL] You want that reference number? It's her name and the, and that date, [PII].
[AGENT][NEUTRAL] No, no, that's OK. OK, so, um, I'm sorry, they said they sent it back for what reason?
[CUSTOMER][NEUTRAL] Every, like, you know, we were sending uh the claim with the primary, you'll be again and again. So what she stated, yeah, what she stated.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Primary paid detail rep per rep, they have the paid claim and they said like uh your representative stated that they have the primary paid and detail, however, as per in system, it is still showing denied for the primary, primary pay details.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So, uh, she sent him back for an interview or something like that.
[CUSTOMER][NEUTRAL] Like, did you, did you guys uh pay?
[AGENT][NEUTRAL] OK, OK, so, um.
[AGENT][NEUTRAL] No, so I did just check um for that date of service I did just go ahead and check and I'm not showing that we have received anything additional from this provider for this state of service. The last information was that claim number that you just gave me ending in 109, um, so I'm not quite sure, give me just a moment.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Yeah, the only record I have is us asking for the primary EOB.
[AGENT][NEUTRAL] So we would need that to be sent to us, correct.
[CUSTOMER][NEUTRAL] No, nothing else.
[CUSTOMER][NEUTRAL] OK. Yeah. I it's through paper, right? You guys accept paper, right? And your mailing address is [PII].
[AGENT][POSITIVE] You can um I've got a mailing address and a fax number whatever is easier for you.
[CUSTOMER][NEUTRAL] Mailing address, I'll just reconfirm that with you. It's [PII].
[CUSTOMER][NEUTRAL] [PII], [PII], OK, then [PII].
[AGENT][NEUTRAL] Correct. Did you want that fax number as well?
[CUSTOMER][NEUTRAL] Oh, no, that's fine. That's that's OK.
[AGENT][POSITIVE] OK, yeah, that's fine and there's no timely filing limit just as soon as you're able to get that to us um we'll be able to continue getting this process.
[CUSTOMER][NEUTRAL] Can you help me?
[CUSTOMER][NEUTRAL] OK, got it. Uh, you're done. And what's the call reference if you don't mind, yeah.
[AGENT][NEUTRAL] Sure, it'd be my first name, last initial, and today's date, uh, so my last initial is A.
[CUSTOMER][POSITIVE] What he, thank you. I appreciate it, [PII] you have a great day.
[AGENT][POSITIVE] Yes, sure. Was there anything else I can help you with?
[CUSTOMER][POSITIVE] No, you've been great. Thank you.
[AGENT][POSITIVE] Alright, of course, thanks for calling APL have a great day bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.