AccountId: 011433970860
ContactId: f91c70ca-8e6b-4f8f-a791-fc11e63a9e6e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 201919 ms
Total Talk Time (AGENT): 91229 ms
Total Talk Time (CUSTOMER): 80442 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/f91c70ca-8e6b-4f8f-a791-fc11e63a9e6e_20250509T18:09_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from broader's office to check on the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII]. And may I have a good contact number in case we disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yup, sure. The contact number is [PII].
[CUSTOMER][NEUTRAL] The policy number of the patient is 025182227.
[AGENT][NEUTRAL] Thank you. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Only one.
[AGENT][NEUTRAL] Alrighty, can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Uh, the data service for my claim is gonna be [PII] of [PII]. Total bill amount is $414 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Yeah, [PII] of 14 uh sorry, [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's Cleveland Clinic, um, Florida, I think so.
[CUSTOMER][NEUTRAL] Just give me a second. Oh yeah, Cleveland Clinic, Florida, also that's known as Cleveland Clinic Western.
[AGENT][NEUTRAL] Alright, I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 3590002.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII]
[CUSTOMER][NEUTRAL] I know this what happened.
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Yeah, right.
[CUSTOMER][NEUTRAL] No, just go ahead. Sorry for the interruption.
[AGENT][NEUTRAL] On [PII], the claim was denied, showing that major medical insurance provided benefits. Um, well, let me say that, let me restate that. Benefits are only payable if major medical provides benefits. So if you have an explanation of benefits showing that major medical has applied something to this claim, you can send the explanation of benefits in from primary, and we can reprocess this claim.
[CUSTOMER][NEUTRAL] OK, you are stating that only if the primary pays the claim, uh, American Public Life Insurance will be getting paid for this claim, I'm, right?
[AGENT][NEUTRAL] No, I'm saying that from the explanation of benefits, it does not show that primary applied to the claim.
[AGENT][NEUTRAL] If they did, and you have an explanation of benefits showing that they did, then submit that explanation of benefits and we can reprocess the claim.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Actually, the primary has been got denied for this claim as a non-covered charges. So it should be also denied by the secondary, right? Only if they uh got allowed the amount, you should be getting paid, am I right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Right, we only apply if primary applies.
[CUSTOMER][NEUTRAL] Am I right?
[CUSTOMER][POSITIVE] OK, got it. Thank you. Have a nice day. Bye-bye.
[AGENT][NEUTRAL] Was there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] No, nothing else. Thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL. Bye-bye.