AccountId: 011433970860
ContactId: dedb33c5-0f79-4ef2-a9a7-53897c2ceb3d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 445390 ms
Total Talk Time (AGENT): 149298 ms
Total Talk Time (CUSTOMER): 134482 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/dedb33c5-0f79-4ef2-a9a7-53897c2ceb3d_20250320T20:55_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] Uh hi. My name is [PII] calling from provider office. I want to discuss the denial on the claim.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim denial, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh yes, callback number is [PII] [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] His policy number is 01813065 M as in Mary, L as in Lima 8.
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh yes. Member's first name is [PII]. Last name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Uh yes, state of service is [PII] and bill amount is $656 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it was 656. OK. And [PII], do you mind if I place you on just a brief hold while I locate the claim?
[CUSTOMER][POSITIVE] Uh yeah, sure. Take your time.
[AGENT][NEUTRAL] Actually, do you have the claim number?
[CUSTOMER][NEUTRAL] Uh, no, I don't have claim number.
[AGENT][NEUTRAL] OK, hold on one moment, OK?
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello Ahi.
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So I'm showing that we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 351.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] 0024.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the insured's primary insurance provided full benefits. There are no benefits available or payable, I'm sorry.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh yes, but uh we can see that on our end, the procedure code J9035 is not fully paid by the Medicare. Uh, they left the uh co-insurance of $18.71.
[AGENT][NEUTRAL] And for that claim, it's requesting the explanation of benefits from primary insurance to be um received for that code, and then we can continue processing for that code.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, we had submit the claim multiple times, but it is denied as a duplicate claim. We submit with the primary payer UOB.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like we received the claim. Let me make sure this is the correct one, yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] This is for
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So for code J9035, um, we received the claim on, hold on one moment, I'm going back to that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] We received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 350.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] I'm sorry, 353-042-2.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because benefits are payable only if the major medical insurance provides benefits. If this claim is later paid by the major medical insurance, please send an explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Just allow me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] years
[CUSTOMER][NEUTRAL] Yes. Uh, do you have fax number because, uh,
[CUSTOMER][NEUTRAL] We want to submit the primary pay you be with through fax.
[AGENT][NEUTRAL] Sure, um, let me know when you're ready.
[CUSTOMER][POSITIVE] Yes, I'm ready.
[AGENT][NEUTRAL] Alright, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] 3.
[CUSTOMER][POSITIVE] OK. Thank you so much. And may I have the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date, and again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Uh thank you so much, [PII]. Have a nice day. Bye for now.
[AGENT][NEUTRAL] You also received. Was there anything else I can assist with?
[CUSTOMER][NEUTRAL] Uh no, that's all for today.
[AGENT][POSITIVE] All right, thanks for calling APL. I hope you have a great day.