AccountId: 011433970860
ContactId: 00738496-4c2a-4781-8351-f4ef21ab5691
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 318489 ms
Total Talk Time (AGENT): 145189 ms
Total Talk Time (CUSTOMER): 149303 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/00738496-4c2a-4781-8351-f4ef21ab5691_20250304T16:53_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, uh, [PII]. I'm calling to know the claim status and eligibility of the patient.
[AGENT][NEUTRAL] OK, I can verify claim status for you. And your name is?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and the initial to my last name.
[AGENT][NEUTRAL] OK, and
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Uh, no, it's not.
[CUSTOMER][NEUTRAL] Nothing. Could you spell your name, please?
[AGENT][NEUTRAL] Sure, it's [PII] and [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] The policy number is?
[CUSTOMER][NEUTRAL] 01677896 M as in Mike L as in Lima 7.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][NEUTRAL] OK, thank you, Ms. [PII], and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] The patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, I'm showing his effective date is [PII]. He is active and what is the date of service and amount of the charge of the claim you're inquiring about?
[CUSTOMER][NEUTRAL] Um, the date of service is [PII] and the charge amount is $76 even. And may I know if APR is primary or secondary?
[AGENT][NEUTRAL] No, this type of policy they have a secondary policy only. And do you have the balance after primary insurance has processed the claim?
[CUSTOMER][NEUTRAL] Yes. And I have the UB which shows that the, this claim process was primary.
[AGENT][NEUTRAL] No, ma'am. We are not primary, we are secondary. Do you have the claim number that you're viewing?
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes. 3553479.
[AGENT][NEUTRAL] Yeah, this is not a primary insurance. Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you're calling from?
[CUSTOMER][NEUTRAL] Pediatrics Medical Group of Florida.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, um, shown on this claim, we paid 2958.
[CUSTOMER][NEUTRAL] Mhm. Yes, but, um, as I told you, we have the explanation of benefits. This process just primary. So could you send the correct to be with the information that it was processed.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, this claim processed as secondary because we only pick up what primary applies towards the deductible, co-pay or co-insurance and and per the explanation of benefits received along with the claim, we pay the 2958. So you may need to change your records.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, I
[CUSTOMER][NEUTRAL] Yes, I understand. So, could you send me the correct GOB?
[AGENT][NEUTRAL] What EOB are you showing? What, what does it say on the explanation benefits you received?
[CUSTOMER][NEUTRAL] Um, in this explanation of benefits it shows that it was processed as primary, so we couldn't get, uh,
[AGENT][NEUTRAL] No, ma'am. It wouldn't say primary. What does the what does the explanation of benefits say?
[CUSTOMER][NEUTRAL] That's what it says I.
[AGENT][NEUTRAL] Does it say that we need additional information or we need a primary insurance information?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, no, the claim processed and paid. I have the COP, but I just need the correct information in the COP that the claim processed is secondary. I understand this claim process.
[AGENT][NEUTRAL] Well our EOB is, our EOB is not gonna say process as primary or secondary. The EOB is going to show that we paid 2958. You see that?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, our EOB is not going to show primary or secondary. This policy they have was a secondary supplemental policy only, and the EOB is just going to show the data service, the code, and it showed how much we paid.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] So if you have that same EOB where it showed at page 2958, that's the same EOB. There's no corrected EOB that's going to be sent.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK. Thank you so much for your assistance. May I know the call reference number?
[AGENT][NEUTRAL] We don't give reference numbers. Is there anything else I can assist you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yeah, that would be hard.
[AGENT][POSITIVE] OK, well I thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye.