AccountId: 011433970860
ContactId: 1c7d2866-1770-4419-a49c-b1d07f55fb17
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 417760 ms
Total Talk Time (AGENT): 136027 ms
Total Talk Time (CUSTOMER): 155926 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/1c7d2866-1770-4419-a49c-b1d07f55fb17_20250523T14:52_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] APL.
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office to verify claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII], and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Two claims?
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, callback number is [PII]. It is a direct line, no extension.
[AGENT][NEUTRAL] Thank you. And may I have the first member's policy number?
[CUSTOMER][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Policy number is 02021828 M as in Mike L as in Lima 7.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] My first name is [PII]. Date of birth is [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] Yes, it is [PII], with the amount of $24,063.46.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] The facility name is HCA Florida, North Florida Hospital.
[AGENT][NEUTRAL] Thank you for that, and I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 356-0302.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And upon verifying the EOB was sent on [PII] to the fax number [PII]. So could you please verify whether you received it or not?
[AGENT][NEGATIVE] Um, as of today, we have not received the fax.
[CUSTOMER][NEUTRAL] OK, the fax number is correct fax number?
[AGENT][NEUTRAL] Yes, that was correct. We also have a payer ID and a mailing address if you'd like.
[CUSTOMER][NEUTRAL] OK. And no only fax number is enough. And could you please help me with the attention to send the fax?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Attention to send the primary UB?
[AGENT][NEUTRAL] Attention is AP APL claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. And that's it. And could you please tell me the call reference number for this number?
[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][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome, hold on one moment.
[CUSTOMER][NEUTRAL] And that then can I provide the next member's member ID?
[AGENT][NEUTRAL] Hold on one moment. Hold on one moment. Let me note this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Yes, it is 02217258 M as in Mike, L as in Lima, 7.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and the date of service and total bills?
[CUSTOMER][NEUTRAL] Yes, the date of service for this member is [PII] with the bill amount of $4,822 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And is it the same provider or would it be a different provider for this member?
[CUSTOMER][NEUTRAL] Uh, it is, uh, for the different provider?
[AGENT][NEUTRAL] OK, and the provider's name?
[CUSTOMER][NEUTRAL] Yes, facility name is HCA Florida Palms West Hospital.
[AGENT][NEUTRAL] Alright, so we are not showing a claim on file for [PII] with your total bills or from your provider.
[CUSTOMER][NEUTRAL] OK. Could you please help me with the claim mailing address to resubmit the claim?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And could you please help me with the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK, and the timely filing limit?
[AGENT][NEUTRAL] Um, there's no timely filing as long as the policy is active on the data service, you can file at any time.
[CUSTOMER][NEUTRAL] OK. And could you please help me with the member's active dates for the policy, effective date and termination date of the policy?
[AGENT][NEUTRAL] The policy is still active and it's been effective since [PII].
[CUSTOMER][NEUTRAL] OK. And the member has any group number or group name for the policy?
[AGENT][NEUTRAL] The group number is 11, I'm sorry, it's 20691.
[AGENT][NEUTRAL] The group name is Thornton Construction.
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK, thank you. And could you please help me with the plan type of the member?
[AGENT][NEUTRAL] This is the Medin supplemental gap insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much and that's it. Thank you for your time and assistance. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. Bye bye.