AccountId: 011433970860
ContactId: dd12bc58-1ad1-4f3f-989a-f195b3651bb8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 346500 ms
Total Talk Time (AGENT): 124956 ms
Total Talk Time (CUSTOMER): 140734 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/dd12bc58-1ad1-4f3f-989a-f195b3651bb8_20250508T18:30_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. Policy number 2255685.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. That's my cell phone number. OK.
[AGENT][POSITIVE] Thank you for
[AGENT][NEUTRAL] Thank you for that. And I have your policy here, and I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Yes, it's, my address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and then just your email address.
[CUSTOMER][NEUTRAL] It's um number [PII].
[CUSTOMER][NEUTRAL] [PII] [PII]. That's the email.
[AGENT][NEUTRAL] OK, this one looks to be your work email?
[CUSTOMER][NEUTRAL] Oh, you have my work email, that would be [PII]. [PII].
[CUSTOMER][NEUTRAL] At [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And how may I help you today?
[CUSTOMER][NEUTRAL] I have a claim that was submitted in [PII].
[CUSTOMER][NEGATIVE] And um I need to know why it was denied.
[AGENT][NEUTRAL] OK, and what's the date of service for the claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] That was [PII] for an ultrasound.
[AGENT][NEUTRAL] All right, hold on one moment. I'm just waiting for the claims to come up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] It was denied requesting an explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] What did that mean?
[AGENT][NEUTRAL] So, we are your secondary insurance, your primary.
[CUSTOMER][POSITIVE] Yes, who you are. Yes.
[AGENT][NEUTRAL] So I'm explaining what that means to you. So the primary is UMR.
[AGENT][NEUTRAL] So they have an explanation of
[CUSTOMER][NEGATIVE] No, no, no.
[CUSTOMER][NEUTRAL] The primary is Cigna.
[CUSTOMER][NEUTRAL] Now UMR it's Cigna. UMR is from May.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. This one is from March from the previous insurance, which is Cigna.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So in our systems from your job, they are letting us know that UMR is the major insurance, so that is who we have on file. If they need to notify us that it's differently.
[CUSTOMER][NEUTRAL] OK, since May.
[CUSTOMER][NEUTRAL] That will be [PII] [PII].
[AGENT][NEUTRAL] OK. All I'm saying to you is these policies come from.
[CUSTOMER][NEUTRAL] That's the brand new one.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And this is a policy that we have since [PII], the same policy.
[CUSTOMER][NEUTRAL] We have a new insurance now, but the claim is not from the new insurance, it's from the Cigna.
[CUSTOMER][NEUTRAL] Provider that we have before.
[AGENT][NEUTRAL] I understand what you're saying, ma'am. All I'm saying is this is an employee benefit policy, so it comes from your job, so I can't change that. That comes from your job. Regardless, if Cigna was the primary at the time, that's whose explanation of benefits they need.
[CUSTOMER][NEUTRAL] That was
[AGENT][NEUTRAL] So it doesn't matter who's showing in our system right now, if Cigna was primary at that time, then that's what they're requesting, the explanation of benefits from Cigna.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] That's uh Gap is requesting that?
[AGENT][NEUTRAL] Yes, because we're 2nd, so we
[CUSTOMER][NEUTRAL] You guys are requesting.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] You request it from Cigna? I'm sorry, you requested from Cigna, or you need, I need to request it from Cigna in order to give it to you?
[AGENT][NEUTRAL] So the Provider Diagnostic Center of Miami filed this claim?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So we sent them an explanation of benefits requesting the explanation of benefits from primary. So we've already requested that with the um provider, but if you have the explanation of benefits, you can also provide it so that we can continue processing the claim.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] No, I don't have it.
[CUSTOMER][NEUTRAL] I never have to do that.
[CUSTOMER][NEUTRAL] Well, I, I was submitted to my.
[AGENT][NEUTRAL] OK, well, you can reach out to diagnostic.
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][POSITIVE] Um, I will submitted to the HR department there. Thank you very much.