AccountId: 011433970860
ContactId: 06c1396a-66dd-4c6c-a118-b6e26c5b06a0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 854390 ms
Total Talk Time (AGENT): 232981 ms
Total Talk Time (CUSTOMER): 233813 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/06c1396a-66dd-4c6c-a118-b6e26c5b06a0_20250326T20:59_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] Hi. Hi, [PII]. My, my name is [PII] calling from provider's office to check the claim status.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status. And [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, just one, [PII].
[AGENT][NEUTRAL] All right, may I have the member's policy number?
[CUSTOMER][NEUTRAL] It's 02120179 M as in Mike, L as in Lima, 7.
[AGENT][POSITIVE] Thank you for that. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Last name is [PII]
[CUSTOMER][NEUTRAL] Date of birth is [PII], sorry, it's [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to look at?
[CUSTOMER][NEUTRAL] It's [PII] and it has range. It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] OK, and may I have the total bills?
[CUSTOMER][NEUTRAL] Uh, it's 31 moment, just a moment, sorry.
[AGENT][POSITIVE] Mhm. Take your time.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's for $316,875.71.
[AGENT][NEUTRAL] Alright, so that's [PII] $316,875.71.
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah it's.
[CUSTOMER][NEUTRAL] on a status. Could you please answer the call the billing department.
[AGENT][NEUTRAL] And [PII], do you mind
[CUSTOMER][NEUTRAL] Uh, while you're checking, can you please spell me your name? Sorry.
[AGENT][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Caller reference number for this call?
[AGENT][NEUTRAL] The call reference number will be my name and today's date.
[CUSTOMER][POSITIVE] Thank you and.
[AGENT][NEUTRAL] You're welcome. Hold on one moment. Um, is it alright if I place you on a brief hold while I look at these claims?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, you carry on.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So there are
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] Um, looks like a total of 3 claims that were received, but none of them are with your total bills. Um, what's the name of the provider on the claim?
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] Uh, it's at Florida West Side Hospital.
[AGENT][NEUTRAL] OK, um, the closest one that was to your
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, can you please check with this bill amount?
[CUSTOMER][NEUTRAL] Sorry to interrupt you. Uh, it's $4,329.13. Is there any bill with that?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Bulama.
[AGENT][NEUTRAL] No, no, there's not.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] However, there's no timely filing, so if you do need to file the claim, you can still um file the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mr. [PII]
[CUSTOMER][POSITIVE] Yes yes.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] OK. Uh, what would be the mailing address?
[AGENT][NEUTRAL] Our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Just a moment. LD RSS.
[CUSTOMER][NEUTRAL] Actually, uh, we received a correspondence stating that the primary OB is needed.
[AGENT][NEUTRAL] OK, what's the claim number on it?
[CUSTOMER][NEUTRAL] Uh, the claim number is 354826-6.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, that's a different date of service. That's [PII]. OK. And have you submitted the explanation of benefits from primary insurance?
[CUSTOMER][NEUTRAL] Yes, we have did and it was submitted on.
[CUSTOMER][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, it was submitted on [PII]. Have you received that one?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] And uh the fax number will be uh for the confirmation, it's [PII].
[CUSTOMER][NEUTRAL] So 9
[CUSTOMER][NEUTRAL] 23.
[CUSTOMER][NEUTRAL] Sorry, it's [PII].
[AGENT][NEUTRAL] Yes, that's our fax number. Just hold on one moment.
[CUSTOMER][NEUTRAL] OK, fine.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] There it is.
[AGENT][NEUTRAL] So let's see if the correct deal is and let me see what this is.
[AGENT][NEGATIVE] Um, what am I doing? I'm looking for RMR actually just forget this. I'm not doing that.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Alright, so it was received because that's gonna be the next question.
[AGENT][NEUTRAL] See, so I saw that.
[AGENT][NEUTRAL] Well, I wouldn't have found this anyway cause he gave me the [PII]. This is the [PII], so it's fine.
[AGENT][NEUTRAL] Let me see what he received. I mean what he sent in.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Thank you so much for holding. So we received the um second claim on [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] That claim number is 35547887.
[CUSTOMER][NEUTRAL] Sorry
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] 355
[AGENT][NEUTRAL] 47887.
[CUSTOMER][NEUTRAL] OK. 35547887. I got that. It's [PII], right?
[AGENT][NEUTRAL] And on
[AGENT][NEUTRAL] [PII] it was received.
[AGENT][NEGATIVE] [PII], it was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because the reference claim is a duplicate of previously submitted expenses.
[AGENT][NEUTRAL] Benefit payment has been made. OK.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Uh, what's the denied date again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Reason, denial?
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] The insured submitted a claim and the payment was paid to the insured.
[CUSTOMER][NEUTRAL] Payment was paid to the insured, OK.
[CUSTOMER][NEUTRAL] Mo paid to.
[CUSTOMER][NEUTRAL] May I know, um,
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Uh, this patient sign the OB?
[AGENT][NEUTRAL] You said that the patient sign the EOB?
[CUSTOMER][NEUTRAL] Not AOB. It's assignment of benefits. Does patient pay um sign the AOB like assignment of benefits that
[AGENT][NEUTRAL] A O B
[AGENT][NEUTRAL] I understand. I just didn't hear you. Thank you. So, the, there is no assignment of benefits. The member can file the claim and as the provider, the member just filed the claim before you did, so their claim was processed first.
[CUSTOMER][NEUTRAL] Yes, AOB.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Uh, what, what was the allowed amount for this one? What the amount you paid to patient?
[AGENT][NEUTRAL] I can't provide you with that information because it's the patient's claim, but for the benefit, um, let me see what the amount was. Hold on one moment.
[CUSTOMER][NEUTRAL] Uh, you can't provide any paid details?
[AGENT][NEUTRAL] No, because it's not your provider claim. It belongs to the patient. You can reach out to the patient to see.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Done, done. I understand.
[AGENT][NEUTRAL] Would you like the benefit amount?
[CUSTOMER][NEUTRAL] Sure, sure.
[CUSTOMER][POSITIVE] Uh, no, it's fine. Thanks for the information, [PII]. Have a great day. Take care. Bye.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help with?
[CUSTOMER][NEUTRAL] No, [PII]. That's fine.
[AGENT][POSITIVE] Alright, thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You do.
[AGENT][POSITIVE] Thank you. Bye-bye.