AccountId: 011433970860
ContactId: d4b83cc7-adb7-480a-bb91-cef31150d09f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 258820 ms
Total Talk Time (AGENT): 70405 ms
Total Talk Time (CUSTOMER): 168542 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/d4b83cc7-adb7-480a-bb91-cef31150d09f_20250310T19:11_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, hi, we, I'm on the line here as the um guarantor of the patient, um, and then we have on an office of my daughter's from my, like the billing from my, one of my daughter's doctor's offices.
[CUSTOMER][NEUTRAL] Um, and we are trying to figure this out here, um.
[CUSTOMER][NEGATIVE] I have a a a service that my daughter had an X-ray and there's a remaining amount after her primary paid for the authority, um, but they said that they sent it to you and you denied it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I can check on claim status for you. Um, first, could I get your name and a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII] and it's [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] Hold on, it's very long.
[CUSTOMER][NEUTRAL] OK, it is 01677.
[CUSTOMER][NEUTRAL] 458 M as in Mary L as in Larry 8.
[AGENT][NEUTRAL] OK, thank you. Um, and please verify your daughter's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], um, and it is [PII].
[AGENT][NEUTRAL] OK. And please verify your name again and your date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] OK. And please verify your mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you. And what's the date of service and bill charges on the claim that you're calling about?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] And they said they sent it to you guys right along and it's for an X-ray.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Part of it's for an ray.
[AGENT][NEUTRAL] OK. Yes, ma'am. I'm showing that the claim is denying because we need the EOB from the primary insurance company. Since we are the secondary insurance, we cover the portion that the, um, that goes to the co-pay, the co-insurance or deductible.
[CUSTOMER][NEUTRAL] Yes ma'am, I, I know, I know what you do. I know what you do, ma'am, um, from the doctor's office or the billing, did you guys send an EOB of the primary along with the claim?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So we don't send EOBs that come directly from the insurance company. We don't have access to it. The insurance has to send that.
[AGENT][NEUTRAL] Um, no, normally, the provider sends the EOB. It doesn't come directly from the primary.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEGATIVE] We're not provided with.
[CUSTOMER][NEUTRAL] Mhm, we're the third party billing so you know we have to get it from them. We don't have access to it to send it to them.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Well, it's gonna be hard to get them to get you guys paid because you're gonna always have to send the primary EOB after they paid. So how do we go about getting that over to American Public Life because it sounds like. Call your insurance and tell them that they need it, you know, we can't, we don't have access to it is what I'm saying when we need it, we have to ask for it, you know, since you're the patient, you have to ask for it for the provider.
[CUSTOMER][NEUTRAL] No, I don't. Well, no, we, we don't have to ask for it, ma'am. That's ma'am, in public life, doesn't the provider's office send you that? Not me. I've never sent that one to them.
[AGENT][NEUTRAL] Yeah, but you actually can if the provider.
[CUSTOMER][NEUTRAL] So you have to request it from your insurance.
[AGENT][NEUTRAL] Right, if the provider doesn't file the claim, then you can file the claim yourself and the payment will go directly to you instead of the provider. So if you can um get access to the EOB ma'am, you can submit the claim yourself.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so I'm not gonna do all that. No, if they wanna get paid, they need to do some of their work. So ma'am, from the billing. That's not our job, ma'am. I'm not gonna argue with you with our process, you know, that's your insurance at the end I will argue. I will argue with you. I'm so cool. So who do I talk to at the doctor's office because they're the people who were supposed to be sending it over.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So you talk to whoever your physician is and whoever handles billing at the physician's office. You've been not at all help. Thanks. OK, well.