AccountId: 011433970860
ContactId: 386b0705-c408-4a65-b6e0-0ce134c2959f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 480790 ms
Total Talk Time (AGENT): 139611 ms
Total Talk Time (CUSTOMER): 90189 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/386b0705-c408-4a65-b6e0-0ce134c2959f_20250403T12:59_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] and I'm calling from Flagler Hospital to check on the status of a claim.
[AGENT][NEUTRAL] OK, well I can definitely help you with the claim status, [PII], and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, my direct line is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] I have it listed here as 01967201.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, [PII] and it's [PII].
[AGENT][NEUTRAL] Thank you, and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Sure, [PII] and the total amount billed was $5,358.32.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] OK, so I just located the claim and it's coming up now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 351.
[AGENT][NEUTRAL] 0767.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting an explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Um, it looks like it was sent through the portal.
[AGENT][NEUTRAL] Mhm. We received it again on March.
[CUSTOMER][NEUTRAL] With a confirmation number.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Oh, I have a confirmation number. Something was sent on the [PII].
[AGENT][NEUTRAL] Yes, um, so that's why I was getting ready to um let you know. So we received it on [PII]. That's claim number 3576782.
[AGENT][NEUTRAL] But on [PII], that claim was denied as a duplicate. So let me look and see what documents were received. Hold on one second.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold, [PII]?
[CUSTOMER][POSITIVE] Not at all, thank you.
[AGENT][NEUTRAL] Alright, you're welcome hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. I had to pull the documents. So, the duplicate that was received, it was, it doesn't have the explanation of benefits though. It's just um the one claim form page.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can we fax the primary EOB or should we send that through paper?
[AGENT][NEUTRAL] Um, yes, you can fax it. Let me double check.
[AGENT][NEUTRAL] Their policy type. Yeah, you can fax it and we also have a um electronic payer ID if you need it as well.
[CUSTOMER][NEUTRAL] OK, I'll take that.
[AGENT][NEUTRAL] OK, so the payer, OK, so the payer ID is 60801.
[CUSTOMER][NEUTRAL] I'll take both.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the um fax number is 877.
[AGENT][NEUTRAL] 365
[AGENT][NEUTRAL] 942 3.
[AGENT][NEUTRAL] And that'll be attention APL claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Attention APL claims department.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, alright, do you have a call reference number for this?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much and um are we still in with timely within timely filing to send this EOB?
[AGENT][NEUTRAL] So there's no timely filing limit as long, well, this is asking for additional information, so as soon as we receive it, we'll continue processing, but there's also no timely filing as long as the policy is active on the date of service.
[CUSTOMER][POSITIVE] OK perfect thank you so much and I appreciate your help. I hope you have a great day.
[AGENT][POSITIVE] Thank you, [PII]. You also, was there anything else I can help with?
[CUSTOMER][POSITIVE] No, that's it. I appreciate it thank you so much.
[AGENT][POSITIVE] Alright, you're welcome thanks for calling APO bye bye.
[CUSTOMER][POSITIVE] Sure, thanks bye bye.