AccountId: 011433970860
ContactId: 0e2921fd-4a47-476d-86fe-6744ab600f3b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1144500 ms
Total Talk Time (AGENT): 321246 ms
Total Talk Time (CUSTOMER): 260993 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/0e2921fd-4a47-476d-86fe-6744ab600f3b_20250529T14:21_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. This is [PII] calling from private office with status.
[AGENT][NEUTRAL] I'm sorry, the phone's breaking up. Can you repeat that?
[CUSTOMER][NEUTRAL] Yeah, I'm from provider office to check the time status.
[AGENT][NEUTRAL] OK, I can help you with the claim status, and may I have your name and a good contact number?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]. The callback number is [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today, [PII]?
[CUSTOMER][NEUTRAL] Uh, yeah, I do have 3 plans.
[AGENT][NEUTRAL] Sorry, my phone went in and out. I apologize. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it's 025.
[CUSTOMER][NEUTRAL] 564627.
[AGENT][NEUTRAL] 025564627.
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][NEUTRAL] OK, hold on one moment, let me try that.
[AGENT][NEUTRAL] Alright, do you mind if I place you on just a brief hold, [PII]?
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What happened to everything? What what is this?
[AGENT][NEUTRAL] OK, hold on, because all my lines are gone. OK, let's just get through this and then I can see what happened. That's too many numbers.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So,
[AGENT][NEUTRAL] For some reason, it's, so that's not pulling up a a policy. Um, can you repeat the policy number for me, please?
[CUSTOMER][NEUTRAL] Yeah, it's 025.
[CUSTOMER][NEUTRAL] 564
[CUSTOMER][NEUTRAL] 62 M as in Mike, L as in Lima, 7.
[AGENT][NEUTRAL] Oh, so it's 2556462.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth is on [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And are all the claims for this member or they're different different members?
[CUSTOMER][NEUTRAL] Uh, yeah, it's for different numbers.
[AGENT][NEUTRAL] OK, may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] The date of service is on [PII]. The total amount is $13,187 even.
[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] Yeah, it's HCA Florida Kendal Hospital.
[AGENT][NEUTRAL] And it's for [PII], correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The reason I'm asking is because I don't see a claim on file from your provider with that total bills. Um, we only have one claim on file for that data service.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can, uh,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I do have the same amount in my end. It's $13,187 even. And the primary left uh after primary, the amount is $3,557.80.
[AGENT][NEUTRAL] Right, I'm not saying that there's no claim. I'm saying that we have not received it. So if you would like to file the claim, you can, but there's only one claim on file for this data service and it's for a different provider with a way less amount. So you can file your claim if you like, but it is not here.
[CUSTOMER][NEUTRAL] Yeah, OK. And can you verify the tax ID again it's uh [PII].
[CUSTOMER][NEUTRAL] You don't have, you don't see any claim, right?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Right, the tax ID that you're giving does not match the claim on file for this data service, so there's no claim on file.
[CUSTOMER][NEUTRAL] Mhm. Yeah, OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Uh, yeah, we can and we will submit the claim again.
[CUSTOMER][NEUTRAL] Uh, can I get the
[CUSTOMER][NEUTRAL] Mm. Mail ID and the mailing address?
[AGENT][NEUTRAL] Sure, sir, pay ID is 60801.
[AGENT][NEUTRAL] My mailing address is um [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm, yeah.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And uh can I get the time limit and the plan information?
[AGENT][NEUTRAL] So there's no timely filing, you can file the claim at any time, and when you say plan information, what do you mean by that?
[CUSTOMER][NEUTRAL] Yeah, can you provide me the plan if I don't it?
[AGENT][NEUTRAL] Hold on one moment. So the policy is still active?
[AGENT][NEUTRAL] And it's been effective since [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, OK. And uh can you provide me the plan name and type?
[AGENT][NEUTRAL] This is a Medlink supplemental gap insurance policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] And can I get the
[CUSTOMER][NEUTRAL] Type of the plan?
[AGENT][NEUTRAL] Again, it's a supplemental gap insurance policy.
[CUSTOMER][NEUTRAL] Yeah, OK. Can I get the group name, group number?
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] Just waiting for the policy um information to come back up. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The group name is Sunshine Gasoline Distributors.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The group number is 80094.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah, that's it and can I be called offenses for this?
[AGENT][NEUTRAL] The call reference number for the entire call will be my name and today's date, and again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, OK, [PII]. And uh
[CUSTOMER][NEUTRAL] Can we move on to the next one?
[AGENT][NEUTRAL] Yes, hold on one moment.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Just a moment. It's loading on my end.
[CUSTOMER][NEUTRAL] The member ID. Are you ready?
[AGENT][POSITIVE] Yes, I'm ready.
[CUSTOMER][NEUTRAL] It's 021.
[CUSTOMER][NEUTRAL] 348
[CUSTOMER][NEUTRAL] 82.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the member's name is [PII] and the read about the song.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and again just for the call, 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 bills?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The rate of services on
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] With the bill amount is $27,354 even.
[AGENT][NEUTRAL] Alright, hold on one moment.
[AGENT][NEUTRAL] Is it alright if I place you on a brief hold?
[CUSTOMER][POSITIVE] Yeah, OK, take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] And then we paid.
[AGENT][NEUTRAL] 57.
[AGENT][NEUTRAL] OK, now I received it again.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Um, no problem what to do.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah, I'm here.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So we've actually received the claim 3 times. Um, were you needing all 3 or just a paid claim?
[CUSTOMER][NEUTRAL] Oh, just a pet la only.
[AGENT][NEUTRAL] OK, so the pay claim we received on [PII].
[AGENT][NEUTRAL] The claim number is 3604357.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim a total of $2000.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And did you need the check information?
[CUSTOMER][NEUTRAL] And uh it was paid us $2000 right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah. And uh may I know the loan amount?
[AGENT][NEUTRAL] $2000.
[CUSTOMER][NEGATIVE] And there is no best, uh, is there any personal responsibility?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility because we're not a major medical insurance company.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh, yeah, we can uh.
[CUSTOMER][NEUTRAL] Can you verify the payment information whether it is paid through check or EFT?
[AGENT][NEUTRAL] OK, so it was a single check.
[AGENT][NEUTRAL] That was mailed.
[AGENT][NEUTRAL] Check number is 204.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 5984.
[AGENT][NEUTRAL] It was mailed to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it was issued on [PII].
[CUSTOMER][NEUTRAL] Still not gas yet, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah. And uh
[CUSTOMER][NEUTRAL] Can you want
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah, OK, can I get the.
[CUSTOMER][NEUTRAL] You'll be through facts.
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] 844
[CUSTOMER][NEUTRAL] 902.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Just a moment. Sorry for the delay.
[AGENT][NEUTRAL] Um, it's OK.
[CUSTOMER][NEGATIVE] My system is loading very slow.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, it's 844.
[CUSTOMER][NEUTRAL] 902
[CUSTOMER][NEUTRAL] 3804.
[AGENT][NEUTRAL] OK, what should the attention be?
[CUSTOMER][NEUTRAL] To the patient's account number. And can you verify once again the check number is 204984. Is that right?
[AGENT][NEUTRAL] No, 204.
[AGENT][NEUTRAL] 5984.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] And to confirm patient account number [PII]?
[CUSTOMER][NEUTRAL] Yeah, right.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] All right, and
[AGENT][NEUTRAL] Alright, so I'll go ahead and fax that to you and the last member's policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 022.
[CUSTOMER][NEUTRAL] 979
[CUSTOMER][NEUTRAL] 12.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] the.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] The member's name is
[CUSTOMER][NEUTRAL] [PII], the date of birth is on [PII].
[AGENT][NEUTRAL] Thank you for that. And again, just for the call, 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] The rates on.
[CUSTOMER][NEUTRAL] Uh, [PII] with the bill amount is $187,046.25.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] Oh sorry.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] you
[AGENT][NEUTRAL] And you said the total bill is $187,046.25?
[CUSTOMER][NEUTRAL] Yeah, right.
[CUSTOMER][NEUTRAL] Yeah, OK, and uh and uh.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] We, we don't need any information for this claim because it is not yet billed.
[AGENT][NEUTRAL] Right, there's no claim on file. All right, well, was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, no, nothing else that I think. That's the time.
[AGENT][POSITIVE] Alright, well, thanks for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Yeah, you too. Have a great day, bye.
[AGENT][POSITIVE] Thank you. Bye bye.