AccountId: 011433970860
ContactId: e3b43eba-24d7-4233-b6f5-99e1955f2370
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 204490 ms
Total Talk Time (AGENT): 87687 ms
Total Talk Time (CUSTOMER): 86077 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/e3b43eba-24d7-4233-b6f5-99e1955f2370_20241231T20:13_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] Hey [PII], yeah, I'm calling uh from a provider's office. I'm trying to find out about a claim please.
[AGENT][POSITIVE] OK, I can definitely help you with the claim status. And may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, my name's [PII]. Phone number is [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have the member's policy number?
[CUSTOMER][POSITIVE] Sure you can. It's gonna be 1066917. I hope that's right.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service for the claim you like me to check on and the total bills?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] mm.
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] $491.
[AGENT][NEUTRAL] 491.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] I'm ready to go on another day of vacation.
[AGENT][NEUTRAL] Almost there.
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] All right, so, um, can you verify the name of the provider on the claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Well, the facility.
[CUSTOMER][NEUTRAL] I'm being silly. I don't mean to be uh that silly. I'm just being.
[AGENT][NEUTRAL] Oh, it's OK. No, you're fine.
[CUSTOMER][NEUTRAL] Completely the um.
[CUSTOMER][NEUTRAL] Let's see, hold on.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Oh, just the facility name.
[CUSTOMER][NEUTRAL] Oh, it's Holy Cross urgent care. Sorry. Give me the provider. Sorry.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] It's all right. I'm just waiting for the claim to come back up. Hold on one moment. So we received the claim on [PII].
[CUSTOMER][POSITIVE] You're totally fine.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The claim number is 353.
[AGENT][NEUTRAL] 587 7.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] So, what you're saying is your secondary and United Healthcare is primary.
[AGENT][NEUTRAL] Um, let me see if.
[CUSTOMER][NEUTRAL] No, actually your secondary is what you're saying?
[AGENT][NEUTRAL] We are secondary, yes, United Healthcare is primary. Mhm.
[CUSTOMER][NEUTRAL] Got you. OK, that's what I thought.
[CUSTOMER][NEUTRAL] Shall we send it to the wrong place? I'm sorry.
[AGENT][POSITIVE] It's all right.
[CUSTOMER][NEUTRAL] Sorry about
[CUSTOMER][NEUTRAL] Um, denied for being secondary. OK, I'll get it to the right place and then we can finally send it over to you guys, um, with the EOB that's appropriate.
[AGENT][NEUTRAL] Yes, and there's no timely filing. So, um, as long as the policy was active on the data service, you can file at any time.
[CUSTOMER][POSITIVE] OK great thank you so much.
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, you have a great rest of the day and have a good holiday tomorrow.
[AGENT][POSITIVE] Thank you, you also, and thanks for calling APO. Bye-bye.
[CUSTOMER][NEUTRAL] Uh-huh, bye.