AccountId: 011433970860
ContactId: 180cebba-ee15-44e6-8d97-4c8e9ff164b5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 974260 ms
Total Talk Time (AGENT): 352757 ms
Total Talk Time (CUSTOMER): 224673 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/180cebba-ee15-44e6-8d97-4c8e9ff164b5_20250430T18:50_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, this is [PII] calling from provider office to check on claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status, [PII]. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm having um just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I am at 25 clients.
[AGENT][NEUTRAL] I can assist you with the 1st 5 and then the others you can do the claim status on our online service center if you'd like.
[CUSTOMER][NEUTRAL] OK. Online service. There is a portal?
[AGENT][NEUTRAL] Yes, that's where you um check the claim status of your claims on our online service center.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But I can assist you with the 1st 5 if you like.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. And may I have um the policy number for the first member?
[CUSTOMER][NEUTRAL] Yeah, it's gonna be 02266030.
[CUSTOMER][NEUTRAL] M as in Mary.
[CUSTOMER][NEUTRAL] L Lima 7.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. Just a moment.
[CUSTOMER][NEUTRAL] And my first name is gonna be uh [PII]. Last name is uh [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] I know but this is gonna be [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 so for this member, do you have multiple claims or just one for this number?
[CUSTOMER][NEUTRAL] Uh, for this phone number.
[AGENT][NEUTRAL] OK, and may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] That's gonna be [PII]. Total charge amount is uh $1,273 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So I'm not showing any claims on file for [PII] for [PII].
[CUSTOMER][NEUTRAL] No claim, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. May I know the effective and term date?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So for this policy, it was active from [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, now there is another policy number after that, uh, [PII]. I can look and see if there's a policy or a claim on that policy.
[CUSTOMER][NEUTRAL] May I know the policy name?
[AGENT][NEUTRAL] Name is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much. Yeah. May I know the term date for this policy APL?
[AGENT][NEUTRAL] For the policy number ending in 6030?
[AGENT][NEUTRAL] Is that the policy you're asking for for the termination date?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, hold on, let me go back to that one.
[AGENT][NEUTRAL] So again, the 4 2,266,030, it was active from [PII].
[CUSTOMER][NEUTRAL] OK. During the data service, 1.
[CUSTOMER][NEUTRAL] Oh, there is no active, right, for this patient.
[AGENT][NEUTRAL] Correct. So there, so there was a policy after that 241-9347. Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you spell your name for documents, sir.
[AGENT][NEUTRAL] Sir, you're asking me for a claim status. Did you want me to continue with the status or give you my name?
[CUSTOMER][POSITIVE] No, thank you so much. May I know your name?
[AGENT][NEUTRAL] My name is [PII], [PII].
[CUSTOMER][NEUTRAL] OK. Shall we move next claim or else uh during this call.
[AGENT][NEUTRAL] There is a
[AGENT][NEUTRAL] OK, hold on one second, sir. [PII], hold on a minute.
[CUSTOMER][NEUTRAL] That is
[AGENT][NEUTRAL] I need to finish this with you. So what I'm explaining to you is there's another policy in between the policy that you gave me that was active during your date of service. Do you want me to check and see if there's a claim here?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, I understand.
[CUSTOMER][NEUTRAL] Yeah, no, we already have UE. The second is gonna be APL. That's why I'm asking that is a UB or not. You told me no claim on for during the data service. There is no patient active since you need to be the patient.
[AGENT][NEUTRAL] Sir, hold on one second.
[AGENT][NEUTRAL] Listen to what I'm saying to you. The policy number that you gave me, 2,266,030, that's the one that wasn't active. There is one after that that was active, that has claims for your date of service. Would you like me to see if there's a claim here for you?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Policy number is gonna be 022.
[CUSTOMER][NEUTRAL] 66,030 M. Mary, L Lima 7. That is active?
[AGENT][NEUTRAL] Listen to that policy was not active on your date of service. There is a policy after this policy number that was active. I've pulled it up and there are claims here from [PII]. Would you like me to see if there's a policy, if there's a claim on the active policy for your date of service because I see three claims here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] All right, so.
[CUSTOMER][NEUTRAL] The total charge amount is gonna be.
[AGENT][NEUTRAL] The active policy num.
[CUSTOMER][NEUTRAL] But my total charge amount is.
[AGENT][NEUTRAL] The active policy number is 241-9347.
[AGENT][NEUTRAL] That policy began active on [PII].
[AGENT][NEUTRAL] So this is the active policy on your date of service and there is a claim here with your total bill. Do you want me to give you that information?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, please provide.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] So we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 350.
[AGENT][NEUTRAL] 0565
[AGENT][NEUTRAL] And on [PII].
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Go ahead, go ahead.
[AGENT][NEUTRAL] On [PII], the claim was denied, requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Can you send me the UB copy through or fax when you are ready I provide my fax number.
[AGENT][NEUTRAL] Yes, what's the best fax number for you to send our EOB to?
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes. Attention is gonna be [PII].
[CUSTOMER][NEUTRAL] Let me.
[AGENT][NEUTRAL] Will you need the explanation of benefits faxed over to you for all the claims that we go over today, for the 5 claims we go over today?
[CUSTOMER][NEUTRAL] OK. Well.
[AGENT][NEUTRAL] I'm asking if you would like the explanation of benefits faxed to you for each claim.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I'll save this. Hold on one moment.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, the next member's policy num.
[AGENT][NEUTRAL] The next member's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Before else, may I know the call reference number?
[AGENT][NEUTRAL] The call reference number for the entire call is going to be my name and today's date. Again, that's [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] The next policy ID is gonna be 02106890 M Mary L Lima 8.
[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] And's first name is [PII] First name is [PII]. Date of birth is [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 bill for the claim?
[CUSTOMER][NEUTRAL] OK, so this is uh [PII], total charge amount is uh $2,032 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so the active policy during your data service is policy number 226-6303.
[AGENT][NEUTRAL] So I'll look on there to see if there's a claim.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] That's gonna be a
[CUSTOMER][NEUTRAL] South Miami Critical INC.
[AGENT][NEUTRAL] Alright, so I'm trying to received the claim and um this is under policy number 226-6303.
[AGENT][NEUTRAL] We received the claim on [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The claim number is 350.
[AGENT][NEUTRAL] 1583.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You're welcome
[AGENT][NEUTRAL] And the next member's policy number whenever you're ready.
[CUSTOMER][NEUTRAL] That's gonna be 02137883 M. Mary Lima 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure. The first name is gonna be uh [PII]. Last name is uh [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] That's gonna be a.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] And this is gonna be [PII]. Total charge amount is uh $2,304 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so the policy number that you gave terminated on [PII]?
[AGENT][NEUTRAL] Let me take a look at the active policy and see if there's a claim on there. Hold on one moment.
[AGENT][NEUTRAL] So the active policy number is 2281863.
[AGENT][NEUTRAL] It's been active since [PII].
[AGENT][NEUTRAL] And I'm checking on there for the uh claim for you. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold while I go through the claims?
[CUSTOMER][NEUTRAL] OK, fine.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.