AccountId: 011433970860
ContactId: 2dbcb440-4d8a-4560-8a1b-43e3cf0b9997
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 704450 ms
Total Talk Time (AGENT): 207923 ms
Total Talk Time (CUSTOMER): 223688 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/2dbcb440-4d8a-4560-8a1b-43e3cf0b9997_20250213T14:40_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey, hi, good morning. My name is [PII] and I'm calling from the provider's office for a medical claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you, [PII], and what is that policy number, please?
[CUSTOMER][NEUTRAL] It's 022.
[CUSTOMER][NEUTRAL] 630
[CUSTOMER][NEUTRAL] 82
[CUSTOMER][NEUTRAL] M as in mango, L as in Lima, 7.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's uh.
[CUSTOMER][NEUTRAL] LJ right. And the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And you say you're calling for claim status, correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what was that date of service and amount of the uh charge?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] It's going to be date of services [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $21,248 even.
[AGENT][POSITIVE] OK, thank you. Give me one moment, please.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And while I'm looking at claim information, let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII], and you are calling from?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I'm calling from the provider's office. It's HA Florida Plants Fish Hospital.
[AGENT][NEUTRAL] OK, um, [PII], I'm showing this claim process as needing the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] I got it. Just a second.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So it is denied for explanation of benefits, right? Can I know who is the primary insurance?
[AGENT][NEUTRAL] Correct, the claim processing need.
[AGENT][NEUTRAL] Uh, you have to contact the policyholder because the policy they have with our company is a secondary policy only.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Can I get the claim mailing address for sending the primary away?
[AGENT][NEUTRAL] Sure, it's, I'm sorry, [PII].
[AGENT][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Is there any time limit for this?
[AGENT][NEUTRAL] Uh, no, sir. There's no time limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please assist, assist me with another claim?
[AGENT][NEUTRAL] OK, sure. Is it for the same patient or different patient?
[CUSTOMER][NEUTRAL] It's for the different patient.
[AGENT][NEUTRAL] OK, give me one moment, please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] OK, and [PII], what is the next policy number, please?
[CUSTOMER][NEUTRAL] 01960247
[CUSTOMER][NEUTRAL] ML 7.
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, and the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And the date of service is going to be [PII].
[AGENT][NEUTRAL] OK, and the total charge amount?
[CUSTOMER][NEUTRAL] It's $45,706 even.
[AGENT][NEUTRAL] And the balance after primary?
[CUSTOMER][NEUTRAL] Just a minute. I'll just do that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, and the balance after primary?
[CUSTOMER][NEUTRAL] Yes, and
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0203
[AGENT][NEUTRAL] OK. Do you have the amount after primary or are you still looking it up?
[CUSTOMER][NEUTRAL] Actually, I can see that it's $45,706 of total charges and uh
[CUSTOMER][NEUTRAL] Uh, primary is completed and it came to the 2nd 1.
[CUSTOMER][NEUTRAL] Secondary
[AGENT][NEUTRAL] Understand. I'm asking, do you have the balance after primary insurance has processed the claim?
[CUSTOMER][NEUTRAL] Yeah, it's $1,816.80.
[AGENT][NEUTRAL] OK, thank you. I'm showing that claim was processed and a check was mailed in the amount of $1,816.80 and this was processed on, give me a moment, [PII], so it's just sent out, uh, just processed yesterday, so a check was mailed out today.
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it's paid on, uh, is it only it's paid, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, is, is it processed or it's, it just paid?
[AGENT][NEUTRAL] The claim processed on [PII], which was yesterday, and a check was mailed today in the amount of $1,816.80.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Is there any check number for this?
[AGENT][NEUTRAL] 2027483.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. What's the turnaround time for the payment information?
[AGENT][NEGATIVE] Well, if the provider hasn't received the check in 30 days from the [PII] and they can send a request to have it for and reissued, but it was just mailed out today.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Got it. Just a second. When was the claim received?
[AGENT][NEUTRAL] Uh, received on [PII].
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And it's processed on [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you so much for that. Uh, I do have 2 more with me. Is that OK for you?
[AGENT][NEUTRAL] Sure, and is it for the same patient or different patient?
[CUSTOMER][NEUTRAL] It's for the different patient.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, and what's the next policy number?
[CUSTOMER][NEUTRAL] It's going to be 02487974 ML 7.
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, and the date of service amount of the charge.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the charge is $4,518 even.
[AGENT][NEUTRAL] And the balance after primary?
[CUSTOMER][NEUTRAL] It's $1,641.96.
[AGENT][NEUTRAL] 96 cents. I'm sorry, say that one more time. $1,641. Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] 141 96 cents.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. And the name of this provider's office?
[CUSTOMER][NEUTRAL] It's Northwest Hospital.
[AGENT][NEUTRAL] OK, I show that claim process is needing the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] And the mailing address is going to be the same, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Uh, what's the timely filing for this claim?
[AGENT][NEUTRAL] There is no time limit.
[CUSTOMER][POSITIVE] No doubt. Got it.
[CUSTOMER][NEUTRAL] Can I get the policy effective termination date of this member?
[AGENT][NEUTRAL] Uh, the policy is still active, effective [PII].
[CUSTOMER][NEUTRAL] When was the claim received?
[AGENT][NEUTRAL] [PII], process on [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And no primary insurance details, right?
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] No, you have to contact the patient.
[CUSTOMER][POSITIVE] Got it. Thank you so much for that, and this is enough for today. Can I get the call reference number for the entire call?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name in today's date.
[CUSTOMER][POSITIVE] Got it. Thank you so much for that. Have a nice day. Bye for now.
[AGENT][POSITIVE] Oh, you're welcome, [PII], and thank you for calling APL. Bye.
[CUSTOMER][NEUTRAL] Bye bye