AccountId: 011433970860
ContactId: 0d6d5ff9-8678-4d01-90a7-c4bc8c96d843
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 524039 ms
Total Talk Time (AGENT): 162725 ms
Total Talk Time (CUSTOMER): 146390 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/0d6d5ff9-8678-4d01-90a7-c4bc8c96d843_20250613T18:58_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, [PII]. My name is [PII]. I'm calling from provider's office for 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're disconnected?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02465027 ML 8.
[AGENT][NEUTRAL] OK, you said 0246 027?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] ML 8 Mary Lima number 8.
[AGENT][NEUTRAL] Right, but the number was 0246027.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm asking because it looks like there's a number missing. Can you repeat the full policy number? You don't have to give the ML 7 or 8.
[CUSTOMER][NEUTRAL] 00245027 M for M, L for Lima, number 8.
[AGENT][NEUTRAL] OK, so now, so I, OK, hold on one moment.
[AGENT][NEUTRAL] What's the member's first and last name?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can you spell the first and last name, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]. OK, thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] And the last name is [PII]
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, so [PII] is the last name. OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] I'm just waiting for the policies to populate. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's date of birth?
[CUSTOMER][NEUTRAL] [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 and the total bill for the claim?
[CUSTOMER][NEUTRAL] [PII] $62,302 even. Can you spell your name for me, please?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] First initials and my last name is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. Hold on one moment.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Here it is.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] HCA Florida Palms West Hospital.
[AGENT][NEUTRAL] Alright, I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 3542349.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Which one is the primary?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, let me check. Hold on one moment.
[AGENT][NEUTRAL] United Healthcare.
[CUSTOMER][NEUTRAL] P as in Peter.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Uh, when was the effective date of the United Healthcare?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, we don't have any of the information for the primary insurance policy. Um, this policy became effective on [PII] and we're second to United Healthcare.
[CUSTOMER][NEUTRAL] 9.
[CUSTOMER][NEUTRAL] Holiday, we have some.
[CUSTOMER][NEUTRAL] Already we have sent the primary will be many times.
[AGENT][NEUTRAL] OK, where did you send it to?
[CUSTOMER][NEUTRAL] That make sense.
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Then
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] So we received the claim again on [PII]?
[CUSTOMER][NEUTRAL] You received the UOB?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Did you need that claim number and the day we processed it?
[CUSTOMER][NEUTRAL] No, just a minute. You received primary will be on [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. And what happened to that?
[AGENT][NEUTRAL] It was denied stating that insured primary insurance provided full benefits, so there are no benefits payable.
[CUSTOMER][NEGATIVE] Why it is denied.
[CUSTOMER][NEUTRAL] Could you tell me slowly I'm documenting the notes.
[AGENT][NEUTRAL] Insured primary.
[AGENT][NEUTRAL] Insurance
[AGENT][POSITIVE] Provided full benefits.
[AGENT][NEGATIVE] There are no benefits payable.
[CUSTOMER][NEUTRAL] What do you have to do for this?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility, um, so the balance would be up to you to determine the next steps.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] There is no patient responsibility.
[AGENT][NEUTRAL] I'm not stating that. I'm stating we do not determine patient responsibility.
[CUSTOMER][NEUTRAL] And is there any provider's responsibility?
[AGENT][NEUTRAL] Ma'am, that's the same question. We don't um provide that.
[AGENT][NEUTRAL] You as the provider would have to determine if it needs to be written off or billed. We don't determine that.
[CUSTOMER][NEUTRAL] X as in X.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] You're welcome. Was there anything else