AccountId: 011433970860
ContactId: e2bedbe6-ccdf-4c58-baf5-a4ed44c472af
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 392869 ms
Total Talk Time (AGENT): 132203 ms
Total Talk Time (CUSTOMER): 100665 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/e2bedbe6-ccdf-4c58-baf5-a4ed44c472af_20250107T13:39_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from doctor's office to check on a claim denial reason.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim [PII]. And [PII], may I have a good contact number in case we're disconnected and your policy or the policy number, sorry.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I mean the callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, and then the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Sure, the policy number is 12.
[CUSTOMER][NEUTRAL] 65678.
[AGENT][NEUTRAL] Thank you. Hold on one moment. And you said you're with the broker's office?
[CUSTOMER][NEUTRAL] No provider office.
[AGENT][NEUTRAL] Oh, provider, I thought you a broker. OK, sorry about that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Hi, my 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 or the claim number for the claim you'd like to go over?
[CUSTOMER][NEUTRAL] Data services [PII].
[CUSTOMER][NEUTRAL] The claim number is 349-9449.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] OK, so the claim was denied requesting an explanation of benefits from the primary insurance and what questions did you have?
[CUSTOMER][NEGATIVE] Yeah, we tried to submit the, the, the, the information twice, um, that was submitted through a mail on [PII] and still the client denying for the same reason.
[AGENT][NEUTRAL] [PII], hold on one second, let me see if I can find the second one.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 49. OK, let me look for the second one. Hold on one moment.
[AGENT][NEUTRAL] And [PII], do you mind if I place you on just a brief hold? I'm gonna look at the documents that were submitted with the second um claim.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah, I'm sure.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So what's being submitted is only one page, is your health insurance claim form. Now, I don't
[AGENT][NEGATIVE] That there's not, there's no explanation of benefits being attached. It's just one page that keeps coming over.
[CUSTOMER][NEUTRAL] So the one which was submitted on [PII].
[AGENT][NEUTRAL] I don't see anything being submitted on [PII], [PII], but we received it in [PII].
[CUSTOMER][NEUTRAL] Yeah, uh, uh, uh.
[AGENT][NEUTRAL] So we received
[CUSTOMER][NEUTRAL] OK. But the
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEGATIVE] But I do see we received a denial for [PII].
[CUSTOMER][NEUTRAL] I mean, uh, OK, it was number 10. I got it.
[AGENT][NEGATIVE] Right. So what's being, I looked at what was the documents that y'all sent over and it's just one page and it's only the claim form. There is no explanation of benefits on here, which is why it was denied for the same reason.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Should we need to submit the claim to address [PII]?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] What about the address we have here uh uh that is [PII].
[AGENT][NEUTRAL] Um, the [PII] address, that was the previous claims mailing address. You can discard that. The only claims mailing address is the [PII].
[CUSTOMER][POSITIVE] OK, thank you and uh.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] What is the timely filing limit to submit the primary UV?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] There's no timely filing because it's asking for additional information, so as soon as we receive it, we'll go ahead and process.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK and uh can I have a code of number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name, which is [PII] The first initial to my last name is [PII], and today's date.
[CUSTOMER][POSITIVE] OK, thank you and have a good day. Bye for now.
[AGENT][POSITIVE] You're very welcome, [PII], and again, all the information provided was a verification of benefits, not a guarantee of payment, and thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah