AccountId: 011433970860
ContactId: 204d4f00-77b0-4004-8391-2228389c3563
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 515179 ms
Total Talk Time (AGENT): 189365 ms
Total Talk Time (CUSTOMER): 177247 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/204d4f00-77b0-4004-8391-2228389c3563_20250519T14:56_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, [PII], my name is [PII] and and I'm calling, hello, and I'm, I'm calling from a provider's office, um, Naples Community Hospital, and I'm trying to I'm trying to get status on a claim.
[AGENT][NEUTRAL] Oh, hi, [PII].
[AGENT][NEUTRAL] OK, [PII], you're needing same the claim status for one member, is that correct?
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am.
[AGENT][POSITIVE] OK, yes, I can help you and [PII], how do you spell your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and mine's [PII]
[CUSTOMER][NEUTRAL] [PII], and what's your last initial, [PII]?
[AGENT][NEUTRAL] [PII], and yours?
[CUSTOMER][NEUTRAL] Got it. [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] Yes, my callback number is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am, the policy number is.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] It says on this, it says on this card, it says inpatient benefit certification number, would that be it?
[AGENT][POSITIVE] OK, that'll work. Yes, ma'am. You can give me that number.
[CUSTOMER][NEUTRAL] OK, 0, OK, 023.
[CUSTOMER][NEUTRAL] 00709 M as in Mary, L like Lima, the number 7.
[AGENT][NEUTRAL] OK, thank you. So give me a couple of moments please to get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII], I'm gonna spell the last name. [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And her date of birth.
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the data service and total bill amount, please?
[CUSTOMER][NEUTRAL] [PII], total bill amount is $71,666.84.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do see that this claim was received. The receipt date on it was [PII].
[AGENT][NEGATIVE] And it was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3,575,080.
[CUSTOMER][NEUTRAL] Hold on, hold on, hold on, 357.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 5
[AGENT][NEUTRAL] 080.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the reason for the denial states, please provide copies of the explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Please provide.
[CUSTOMER][NEUTRAL] EOB
[AGENT][NEUTRAL] Uh-huh, from primary insurance carrier.
[CUSTOMER][NEUTRAL] From primary.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So let me ask you a question, so you guys are not the primary.
[AGENT][NEUTRAL] No, ma'am. We're a sup we're not a major medical carrier. This is a supplement to her primary insurance.
[CUSTOMER][NEUTRAL] OK, give me 1 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, her primary denied it because of COB.
[CUSTOMER][NEUTRAL] That is crazy.
[AGENT][NEUTRAL] I don't know about that. I don't know if she has any other, but this is a supplement to her United Healthcare through her employer.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] So you received it on the [PII]. It was processed on the [PII], process, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The plane number was 3,575,080, is that correct?
[AGENT][NEUTRAL] Mhm. That is, yes, it is. Uh-huh.
[AGENT][NEUTRAL] And if you need a copy of our explanation of benefits with a remark on it as to what we're needing, you can't, you should be able to print that rather if you go to our portal, [PII], now that you have the claim number and our website for our portal is secured.
[CUSTOMER][NEUTRAL] You should be fine.
[AGENT][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. Yes, yes, and secure does have a D on it. Yes, you would say it's a self-registering portal.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Do I need to set up a log in and pass?
[CUSTOMER][NEUTRAL] Yes ma'am. Do I need to set up a login and password for that? OK.
[AGENT][POSITIVE] Correct, yes, you would, uh-huh.
[CUSTOMER][POSITIVE] OK, let me make sure I got everything I need.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Your name is [PII], you see.
[CUSTOMER][NEUTRAL] So if I, so we've seen.
[CUSTOMER][NEUTRAL] If I send you the EOB now, could I find an appeal for it or no?
[AGENT][NEUTRAL] You, we just need to, uh, you can fax the EOB to us. That's all we need, not another claim. We just need the primary insurance company's explanation of benefits for this particular claim that we've already received.
[CUSTOMER][NEUTRAL] What's the fax number?
[AGENT][NEUTRAL] It is [PII] attention claims department.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] That's correct, yes ma'am.
[CUSTOMER][NEUTRAL] OK, give me one second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I gotta make sure I ask all my questions.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Is there a call reference number for this?
[AGENT][NEUTRAL] You would use my name along with today's date.
[CUSTOMER][POSITIVE] OK, that's easy.
[AGENT][POSITIVE] Yeah, it's pretty easy.
[AGENT][NEUTRAL] So is there anything else, [PII] that I can help you with this morning?
[CUSTOMER][NEUTRAL] No, ma'am. That was it.
[AGENT][POSITIVE] OK, well then, thank you so much for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.