AccountId: 011433970860
ContactId: 2dacac60-c2d0-4f7a-aee5-0cd7cd7ebfd8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 831760 ms
Total Talk Time (AGENT): 257639 ms
Total Talk Time (CUSTOMER): 261412 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/2dacac60-c2d0-4f7a-aee5-0cd7cd7ebfd8_20250512T13:37_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] Hi, [PII]. My name is [PII]. I'm looking for medical claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Yes, I am, ma'am, total of 5 clients. It's a different patient.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected and the first member's policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure. My contact number is [PII].
[CUSTOMER][NEUTRAL] And the policy number is 021-98427.
[AGENT][NEUTRAL] OK, can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII] and 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] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, uh, [PII] and the total bill amount is $49,494.60.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yes, HA Freedom Northwest Hospital.
[AGENT][NEUTRAL] Alright, I'm sure you received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 9323.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK, uh,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Previously, the, we send this primary on [PII]. We submit through fax. The fax number is [PII]. Is the correct fax number?
[AGENT][NEUTRAL] Yes, that is correct, but we have not received the document.
[CUSTOMER][NEUTRAL] OK. Uh, this time, I submit to your mailing address. May I have your mailing address?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK, I know. Any time limit for this primary you'll be resuming?
[AGENT][NEUTRAL] No, for additional information, um, there's no filing limit. Once we receive it, we'll continue processing.
[CUSTOMER][NEUTRAL] OK. Shall I move to next claim?
[AGENT][NEUTRAL] Um, hold on one moment. I have to know each policy as we go.
[CUSTOMER][POSITIVE] OK. No problem.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Yes, 02408923. M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] And the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, first name is uh [PII] and last name is [PII] and date of the [PII].
[AGENT][POSITIVE] Thank you for that and the data service and the total bills.
[CUSTOMER][NEUTRAL] Yes, uh, [PII] and the total bill amount is $22,907.52.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And will the name of this provider on this claim be the same or different?
[CUSTOMER][NEUTRAL] No, it's a different. It's HC Florida Hotel Hospital.
[AGENT][NEUTRAL] OK, so the claim was originally received on [PII].
[AGENT][NEUTRAL] That claim number is 354-8890.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK. Uh, this one.
[AGENT][NEUTRAL] And it looks like we
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEGATIVE] And it looks like we received a um second claim for this on [PII], but this was denied as a duplicate. Um, so the explanation of benefits still has not been received.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, OK. Uh, this one also we send on [PII], we submit through your mailing address [PII]. Did you receive the primary EOB?
[AGENT][NEGATIVE] No, we have not received the primary EOB. We only received the corrected claim in February. That was the last thing we received for this member.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, may I have your fax number?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Attention to
[AGENT][NEUTRAL] APL claims department.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, the next number when you're ready.
[CUSTOMER][NEUTRAL] Uh, are you
[CUSTOMER][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] The policy number is 01723392.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Thank you and the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes. Uh first name is [PII]. Uh last name is [PII], uh [PII] uh sorry, [PII] And date of this [PII].
[AGENT][POSITIVE] Thank you for that and the total bills and the data service.
[CUSTOMER][NEUTRAL] Yes, [PII] and the total charges $3,344 even.
[AGENT][NEUTRAL] OK, hold on one moment. And the name of the provider on this claim?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's HA Frida Lucy Hospital.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] Claim number is 351.
[AGENT][NEUTRAL] 826 4.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] Uh, this one also we send on [PII]. We submit through the same, your mailing address. Did you receive the primary copy on [PII]?
[AGENT][NEUTRAL] No, we have not. We only received this original claim.
[CUSTOMER][NEUTRAL] OK. I will submit to fax. OK. When you're ready, I, I move to next claim.
[AGENT][POSITIVE] Hold on one moment, thank you.
[CUSTOMER][POSITIVE] Yes, no problem.
[AGENT][NEUTRAL] OK, and the next one's policy number?
[CUSTOMER][NEUTRAL] Yes, 01978557. M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, first name is uh [PII] and last name is [PII], and date of the [PII].
[AGENT][POSITIVE] Thank you for that and the data service and total bills.
[CUSTOMER][NEUTRAL] Uh, data services on [PII] and the total charges $13,715 even.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And the name of the provider on this claim?
[CUSTOMER][NEUTRAL] It's a Freedom Mercy Hospital.
[AGENT][NEUTRAL] Alright, so I'm sure we received this claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3558917.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Uh, this one we send on [PII], we submit through fax, same fax number. Do you, do you receive the primary on [PII]?
[AGENT][NEUTRAL] No, we have not received the primary EOB yet.
[CUSTOMER][NEUTRAL] OK. This time I submit to your mailing address. Same mailing address for this member, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Previously provide
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Shall I move to last claim?
[AGENT][POSITIVE] Yes, I'm ready.
[CUSTOMER][NEUTRAL] Yes, uh, the policy number is 02556489 M as in Mike L as in Lima, number 7.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes. First name is [PII]. Last name is [PII], and date of the [PII].
[AGENT][POSITIVE] Thank you for that and the date of service and the total bills.
[CUSTOMER][NEUTRAL] Yes, [PII]. And the total bill amount is $4,728 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] For [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Yes. [PII].
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, here we go. Hold on one moment.
[AGENT][NEUTRAL] And the name of the provider on this claim?
[CUSTOMER][POSITIVE] It's safe for the ventura Hospital.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] 4 52 8.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting a detailed explanation of benefits that shows the amount applied to the deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] Uh yes. Uh, this primary will be also sent on [PII] is through your mailing address. Do you receive the primary OP?
[AGENT][NEGATIVE] No, we have not received it yet.
[CUSTOMER][NEUTRAL] OK, this time I submit to fax. OK. Thank you, [PII]. Do you have any call reference number for all these 5 calls?
[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] OK. Thank you, [PII]. Thank you for your assistance. Have a good day.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] That's it. Thanks for your assistance.
[AGENT][POSITIVE] Alright. You're welcome. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You too. Bye. Yeah.