AccountId: 011433970860
ContactId: 32353942-fd72-4ac3-bcf4-b9bb3d78a1e9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 820400 ms
Total Talk Time (AGENT): 290349 ms
Total Talk Time (CUSTOMER): 331222 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/32353942-fd72-4ac3-bcf4-b9bb3d78a1e9_20250210T16:15_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] Hello, this is [PII] calling from the provider's office to check on a claim status.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you with that claim status. What is the callback number?
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] Policy number is 024.
[CUSTOMER][NEUTRAL] After that, it is.
[CUSTOMER][NEUTRAL] 13429.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] So, patient's name, [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] It's, what is the first name?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you with that claim status for [PII]. What is the date of service, please?
[CUSTOMER][NEUTRAL] So, the date of service is going to be
[CUSTOMER][NEUTRAL] [PII]. And the billed amount is $7,838 even.
[AGENT][NEUTRAL] All right, thank you. And what is the name of the facility, please?
[CUSTOMER][NEUTRAL] The name of the facility is HC Florida Palms West Hospital. And may I get your name, sorry, missed out?
[AGENT][NEUTRAL] Sure. My name is [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] My pleasure. I, we did receive that claim on [PII].
[AGENT][NEUTRAL] Processed on [PII], the claim is pending for the Cigna Primary EOB.
[CUSTOMER][NEUTRAL] Just one moment. And may I get the claim number?
[AGENT][NEUTRAL] Sure, that claim number is 353.
[AGENT][NEUTRAL] 4046.
[CUSTOMER][NEUTRAL] OK. For this one, we have sent that you'll be twice. One is on [PII].
[CUSTOMER][NEUTRAL] And the another one is on
[CUSTOMER][NEUTRAL] [PII]. Can you please check on both these dates whether that you received on your end?
[AGENT][NEUTRAL] Yeah, I was looking for those dates. We have not received claim documents on those dates. Can we verify the fax number? What fax number was that sent to?
[CUSTOMER][NEUTRAL] It was sent to [PII]. And the next one.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII]. Yes. It was sent to that fax number?
[AGENT][NEUTRAL] That is the correct fax number. We did not. It never came through. There's two options, um, you can refax it to that address, you can mail it or I can help you create an online account and you can just upload the EOB directly on the policy.
[CUSTOMER][NEUTRAL] Did you receive the fax?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, I can refax it to you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it, it was the same fax number, right?
[AGENT][NEUTRAL] That's correct. [PII].
[CUSTOMER][NEUTRAL] OK. And can you please kindly check if the UPO is attached with the claim form?
[AGENT][NEUTRAL] I can check that original claim. One moment.
[CUSTOMER][NEUTRAL] Mhm. Sure.
[AGENT][NEGATIVE] For the original claim, we only received the UBO4. We did not receive the primary EOB.
[CUSTOMER][NEUTRAL] OK. So the UP is not attached, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. So that I can send the fax to you.
[AGENT][NEUTRAL] Mhm. You can. Now.
[CUSTOMER][NEUTRAL] And I don't have 2 more claims. Can you, mhm.
[AGENT][NEUTRAL] Sure, I was just gonna let you know that you can just send the EOB referencing the policy number and claim number. You don't have to send the UBO4 again.
[CUSTOMER][NEUTRAL] Sure. We can uh we'll be sending only the explanation of benefits to you, the primary explanation of benefits.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please assist me with the 2 more claims?
[AGENT][NEUTRAL] I can. Is it for the same patient or a different patient?
[CUSTOMER][NEUTRAL] It is for a different patient.
[AGENT][POSITIVE] All right, well, it would be my pleasure to continue assisting you with claim status. I am ready for that next policy number whenever you are.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes, I'm ready. In my end is 02282219.
[AGENT][NEUTRAL] Thank you, [PII]. And what is that patient's name and date of birth?
[CUSTOMER][NEUTRAL] So, this patient's name is [PII]. One moment. Is it, OK, [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what is that data service?
[CUSTOMER][NEUTRAL] So, the date of service is
[CUSTOMER][NEUTRAL] [PII]. And the billed amount is $8,884.47.
[AGENT][POSITIVE] Thank you, [PII] is it.
[AGENT][NEUTRAL] For a different provider.
[CUSTOMER][NEUTRAL] One moment. Let me check that for you. It is Lewis Gale Hospital.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Yes, we did receive that claim on [PII].
[AGENT][NEUTRAL] Processed on [PII].
[AGENT][NEUTRAL] It is also pending for the primary EOB.
[CUSTOMER][NEUTRAL] From [PII], right?
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK. For this one, we have sent you will be on
[CUSTOMER][NEUTRAL] December.
[CUSTOMER][NEUTRAL] So sorry, [PII]. Can you please kindly check on [PII], where they have received any EOP?
[AGENT][NEUTRAL] We do not have a
[AGENT][NEUTRAL] We did not on [PII].
[CUSTOMER][NEUTRAL] And it should be from the fax number starting with the area code 844.
[CUSTOMER][NEUTRAL] And it was sent to the mailing address PO Box 248,950, Oklaho[PII].
[AGENT][NEUTRAL] We have not received that EOB yet.
[CUSTOMER][NEUTRAL] Even on the
[CUSTOMER][NEUTRAL] Even through the mail?
[AGENT][NEUTRAL] Was that, was it mailed [PII] as well?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] It may not, it just may not have had enough time to get to us by mail.
[CUSTOMER][NEUTRAL] OK, then we'll fax it again to you if that was not received through mail.
[AGENT][NEUTRAL] Yeah, and it may just be that it's still, you know, sometimes the mail takes a little longer.
[CUSTOMER][NEUTRAL] OK. Then,
[CUSTOMER][NEUTRAL] I'd be able to send it through the fax. And it has to be sent to the same fax number, right?
[AGENT][NEUTRAL] The same fax number [PII]. Would you like that claim number?
[CUSTOMER][POSITIVE] OK. Great.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Is it ends with 7042?
[AGENT][NEUTRAL] It does.
[CUSTOMER][POSITIVE] OK. Thank you so much for the confirmation. Let me go ahead and get the next one here.
[AGENT][POSITIVE] OK. I'm ready.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It is still loading.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] OK. I'm ready.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Already? OK.
[CUSTOMER][NEUTRAL] Let me open this one.
[AGENT][NEUTRAL] If you have the original claim number, I can look it up by that as well, either way.
[CUSTOMER][NEUTRAL] OK. The policy number is
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] And I'm sorry, [PII], I didn't mean to interrupt you.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] That's OK. I have a I just have only the duplicate claim number here.
[AGENT][NEUTRAL] That's fine. What's the claim number?
[CUSTOMER][NEUTRAL] Uh sorry, I got the original claim number. It is 3492953.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is that patient's name and date of birth?
[CUSTOMER][NEUTRAL] And this patient's name is [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Alright this for data service 621-24?
[CUSTOMER][NEUTRAL] 6:20.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yes, $2,129.86 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check that duplicate claim. It looks like we just received the UBO4 again, but I will check to make sure.
[AGENT][NEUTRAL] That that um
[AGENT][NEUTRAL] EOB was not attached. Let me get that pulled up for you.
[CUSTOMER][NEUTRAL] Uh, can you please provide me the original claim details?
[AGENT][NEUTRAL] Well, the original claim.
[AGENT][NEUTRAL] We received.
[AGENT][NEUTRAL] Let me get that for you, bear with me.
[CUSTOMER][NEUTRAL] Mhm. Sure.
[AGENT][NEUTRAL] Original claim we received on [PII] and processed on [PII], pending that primary EOB.
[CUSTOMER][NEUTRAL] 11
[CUSTOMER][NEUTRAL] 8
[CUSTOMER][NEUTRAL] Mhm. May I get the claim number?
[AGENT][NEUTRAL] The claim number 352-7969, that's the number you gave me.
[CUSTOMER][NEUTRAL] No, I gave a different number.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] That's the original claim number.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] 3492953
[AGENT][NEUTRAL] No, this one is the one for Park Ridge East Hospital.
[AGENT][NEUTRAL] For data service 621, the claim number is 352-7969. That's the original claim number.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 352-796-9, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][NEUTRAL] And then that's the original pending for the primary EOB on.
[CUSTOMER][NEUTRAL] From United Health.
[AGENT][NEUTRAL] That's right. And then we received the UBO4 again on [PII] process on [PII] as a duplicate. No EOB was attached.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I got the original claim details.
[CUSTOMER][NEUTRAL] So, let me also fax this EUB to you so that the claim can, will get reprocessed.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Thank you so much for time and assistance. Have a good day. Take care. Bye for now.
[AGENT][POSITIVE] Well, [PII], it was a pleasure to assist you with that claim status. If there's nothing else I can help you with, I hope you have a wonderful day and thank you for calling APL.
[CUSTOMER][POSITIVE] You do the same. Thank you. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.