AccountId: 011433970860
ContactId: ec59a337-6265-4473-9dd0-268a28bcfaed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 282959 ms
Total Talk Time (AGENT): 84331 ms
Total Talk Time (CUSTOMER): 88034 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/ec59a337-6265-4473-9dd0-268a28bcfaed_20250212T17:30_UTC.wav
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[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from Forest office looking for a claim status.
[AGENT][NEUTRAL] OK, I can check in a claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII]. It's a direct line.
[AGENT][NEUTRAL] OK, thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, the phone number I have here.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII] for [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that problem. Uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII] it got billed for $259 and even.
[AGENT][NEUTRAL] OK, that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] 88
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So we did receive this claim from we were unable to pay a benefit, uh this is not a covered loss under their plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. But I can receive it, can I take claim number.
[AGENT][NEUTRAL] Uh yes, one moment.
[AGENT][NEUTRAL] OK, so that claim number is 3547441.
[AGENT][NEUTRAL] And it was received [PII].
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] Mhm. And then is not a covered benefits.
[AGENT][NEUTRAL] That's correct. Uh, do you need to be of this EOB?
[CUSTOMER][NEUTRAL] Um, do receive an EV but atta, uh, no other information just a claim number, and, uh, could you help me with the reason why the claim was still not covered.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEGATIVE] It's not covered under this patient's plan.
[CUSTOMER][NEUTRAL] Do you have a plan type for the patient?
[AGENT][NEUTRAL] Yes, this is a secondary medical plan so it is supplemental.
[CUSTOMER][NEUTRAL] And uh may I know who's acting as primary for this patient?
[AGENT][NEGATIVE] Uh, I'm unable to see that from as this, this is just their secondary.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And I don't see here just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I do see here like Ambiter is acting as a primary for this patient and I'll go ahead and submit a claims to Medi sorry, Ambitter and I'll submit a claim again to APL with Ambater COP, the primary COP.
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] Is that fine to process a claim again?
[AGENT][NEUTRAL] Yeah, that's perfectly fine if you feel like there was information missing.
[CUSTOMER][POSITIVE] Sure, and thanks for assisting. Could you help me call reference?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] last initial is [PII] Was there anything else I could help you with [PII]?
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][POSITIVE] No, thank you, [PII]. Thanks for assisting for the day.
[AGENT][POSITIVE] OK, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Yeah bye now take care.
[AGENT][POSITIVE] Thank you, bye bye.