AccountId: 011433970860
ContactId: fbf60b56-c0ff-4bba-bd74-ebf2d280d9a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 405480 ms
Total Talk Time (AGENT): 136263 ms
Total Talk Time (CUSTOMER): 148771 ms
Interruptions: 6
Overall Sentiment: AGENT=-0.3, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/fbf60b56-c0ff-4bba-bd74-ebf2d280d9a7_20250428T16:27_UTC.wav
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[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 Pros office checking on our claim status.
[AGENT][NEUTRAL] OK, I could check on a claim for you and uh can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]. It is a direct line.
[AGENT][NEUTRAL] Thank you and do you have that listing number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Do you have that number.
[CUSTOMER][NEGATIVE] There is no extension.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, do you have the policy number?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] 02292
[CUSTOMER][NEUTRAL] 666.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. uh, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] [PII]. The amount is.
[CUSTOMER][NEUTRAL] Uh, $9,621 even.
[AGENT][POSITIVE] OK, got it, thank you one moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEGATIVE] OK, so we did receive this claim, [PII], however, the explanation of benefits that we received, uh, is incorrect. It does not, um, match the claim information so we were sent the wrong EOB.
[CUSTOMER][NEUTRAL] However, the explanation of benefits that we
[CUSTOMER][NEUTRAL] Uh, it's just not, um, that's the claim.
[CUSTOMER][NEUTRAL] Uh, could you please provide me the claim number?
[AGENT][NEUTRAL] Yes, that is 3583679.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Received and denied it.
[AGENT][NEUTRAL] Uh, one moment, I'll get that.
[AGENT][NEUTRAL] OK, this claim was received [PII] or excuse me, I'm sorry, uh it was received [PII] and was processed [PII].
[CUSTOMER][NEUTRAL] I'm sorry, uh, it was.
[CUSTOMER][NEUTRAL] process
[CUSTOMER][NEUTRAL] Deny the reason.
[AGENT][NEUTRAL] We received the incorrect and incorrect uh primary EOB we need the correct one.
[CUSTOMER][NEUTRAL] That is correct, the incorrect, uh primary.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, primary insurance is Cigna.
[AGENT][NEUTRAL] OK, yes. Oh, so we need that, we need that EOB from this, yes.
[CUSTOMER][NEUTRAL] Let me verify which one we submit.
[CUSTOMER][NEUTRAL] Uh, ma'am, for a clarification, uh, which, uh, primary you you received?
[AGENT][NEGATIVE] Um, it was for, uh, it was just that a wrong one that did not match the actual claim information.
[CUSTOMER][NEUTRAL] For, uh, it was just
[CUSTOMER][NEGATIVE] not match the actual.
[AGENT][NEUTRAL] I can send you this EOB if you'd like, [PII].
[CUSTOMER][NEUTRAL] I can
[CUSTOMER][NEUTRAL] Um, and no need, ma'am. Uh.
[CUSTOMER][NEUTRAL] You got a denied one or uh processed paid one?
[CUSTOMER][NEUTRAL] Because I have to mention this information in my notes, that's why.
[AGENT][NEGATIVE] Um, for the EOB just didn't match what the claim information that we received, so we just received the wrong information.
[CUSTOMER][NEUTRAL] Um, that you just didn't match what the claim information that we so if we just received the wrong information.
[CUSTOMER][NEUTRAL] Uh, I can understand that you got a wrong UP, but, uh, could you please explain which information is wrong?
[CUSTOMER][NEUTRAL] For entire patient information or uh just claim information?
[AGENT][NEUTRAL] The primary EOB.
[AGENT][NEGATIVE] The primary EOB, um, it was wrong it didn't match the claim information.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So we just need the primary EOB for this claim.
[CUSTOMER][NEUTRAL] The primary
[CUSTOMER][NEUTRAL] I need a primary.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can I get the mailing address to submit or a fax number?
[AGENT][NEUTRAL] Uh, I do, yes, I have a mailing address and a fax number. Our address is [PII].
[CUSTOMER][NEUTRAL] Uh, I just, yes, I have a mainly just give us that number. Our address is.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Fax number?
[AGENT][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Be
[CUSTOMER][NEUTRAL] Let me verify the fax number, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Attention to
[AGENT][NEUTRAL] Claims department.
[CUSTOMER][NEUTRAL] OK. Family filing limit to submit the primary?
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, could you please spell your name? You said your name is [PII], right?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] Call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh, so my last initial is [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] That's it, ma'am. Thank you so much. Have a great day. Bye-bye. Take care.
[AGENT][POSITIVE] Of course, thanks for calling APL you too thank you bye bye.