AccountId: 011433970860 ContactId: 3a8001ff-52bd-4cc1-b850-14082c4fd261 Channel: VOICE LanguageCode: en-US Total Conversation Duration: 1744650 ms Total Talk Time (AGENT): 459213 ms Total Talk Time (CUSTOMER): 524096 ms Interruptions: 5 Overall Sentiment: AGENT=0.3, CUSTOMER=0.2 Redaction Types: PII Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/3a8001ff-52bd-4cc1-b850-14082c4fd261_20250327T12:50_UTC.wav -------------------------------------------- [AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you? [CUSTOMER][NEUTRAL] Hey, hi, this is [PII] calling from the priority's office to check on the claim status. [AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status and from my notes, can you spell your first name for me please and provide a good contact number? [CUSTOMER][NEUTRAL] I [CUSTOMER][NEUTRAL] What [CUSTOMER][NEUTRAL] [PII] and the good callback number will be [PII]. [AGENT][NEUTRAL] OK, I, I'm asking you to spell your name because I couldn't hear you. Are you saying [PII] like [PII] or [PII]? [CUSTOMER][NEUTRAL] Yes, yes. [AGENT][POSITIVE] Thank you. And [CUSTOMER][NEUTRAL] Yes, [PII] OK, go ahead. [CUSTOMER][NEUTRAL] But [AGENT][NEUTRAL] And um may I have the member's policy number? [CUSTOMER][NEUTRAL] Yes, it is 02419388 M as in Mike, L as in Lima number 7. [AGENT][NEUTRAL] Thank you for that and [PII], how many claims do you have in total today? [CUSTOMER][NEUTRAL] Only one. [AGENT][NEUTRAL] All right, and can you verify the member's first and last name and date of birth? [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] My first name is [PII] and the last name is [PII]. 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. May I have the date of service for the claim you like me to check on? [CUSTOMER][NEUTRAL] Oh. [CUSTOMER][NEUTRAL] [PII] but the amount was $72,0099 even. [CUSTOMER][NEUTRAL] Yeah. [AGENT][NEUTRAL] OK, hold on one moment. [CUSTOMER][NEUTRAL] Are you sure? [CUSTOMER][NEUTRAL] Any further detail [CUSTOMER][NEUTRAL] You [AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim? [AGENT][NEUTRAL] Hello, [PII]. [CUSTOMER][NEUTRAL] Yes, it is HC Florida Mercy Hospital. [AGENT][NEUTRAL] OK, so we don't have a claim on file um from your provider for that data service. [CUSTOMER][NEUTRAL] Yeah [CUSTOMER][NEUTRAL] OK, give me a moment. [AGENT][NEUTRAL] OK. [CUSTOMER][NEUTRAL] So we send via mailing address. The mailing address has just confirmed whether it is correct or not, we will, uh we sent to [PII]. Is this the correct mailing address you billed to? [AGENT][POSITIVE] Yes, that's correct. [CUSTOMER][NEUTRAL] OK. So do you have any payer ID? [AGENT][NEUTRAL] Yes, it's 60801. [CUSTOMER][NEUTRAL] Mhm. OK. Give me a moment. [AGENT][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] So what is the effective and termination date of the member? [AGENT][NEUTRAL] Hold on one moment. [CUSTOMER][NEUTRAL] So [CUSTOMER][NEUTRAL] Yeah [AGENT][NEUTRAL] The policy was effective from [PII]. [CUSTOMER][NEUTRAL] Um [CUSTOMER][NEUTRAL] Yeah [CUSTOMER][NEUTRAL] Give me a moment. [CUSTOMER][NEUTRAL] OK. May I know the timely filing to resubmit this claim? [AGENT][NEUTRAL] So there's no timely filing as long as the policy was active on the data service, you can file at any time. [CUSTOMER][NEUTRAL] Mm. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] And may I know the group name? [CUSTOMER][NEUTRAL] Yeah [AGENT][NEUTRAL] Hold on one moment. [AGENT][NEUTRAL] Sunshine [CUSTOMER][NEUTRAL] Yeah [AGENT][NEUTRAL] Gasoline. [AGENT][NEUTRAL] Distributor [CUSTOMER][NEUTRAL] Uh, this year. [AGENT][NEUTRAL] Distributors. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] We do have [CUSTOMER][NEUTRAL] Group number, please. [CUSTOMER][NEUTRAL] Um [AGENT][NEUTRAL] Um, 24399. [CUSTOMER][NEUTRAL] OK. And the plan type? [AGENT][NEUTRAL] This is a Medlink supplemental gap insurance. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] And uh member is the policyholder or he's a subscriber? [AGENT][NEUTRAL] Uh, [AGENT][NEUTRAL] It's the same, it's the policyholder. [CUSTOMER][NEUTRAL] Yeah. [CUSTOMER][NEUTRAL] OK [AGENT][NEUTRAL] Hold on one moment. Let me double check. [AGENT][NEUTRAL] Oh, neither. He's a dependent, my apologies. [CUSTOMER][NEUTRAL] OK. What, who is the policyholder? May I know his name? [AGENT][NEUTRAL] Um, her name is [PII]. [CUSTOMER][NEUTRAL] Uh, can you uh spell the last name? [AGENT][NEUTRAL] [PII] [AGENT][NEUTRAL] [PII]. [CUSTOMER][NEUTRAL] Yeah. [AGENT][NEUTRAL] [PII]. [AGENT][NEUTRAL] [PII] [AGENT][NEUTRAL] [PII] [CUSTOMER][NEUTRAL] I do. [AGENT][NEUTRAL] [PII]. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] OK. And the relation with that uh subscriber? [AGENT][NEUTRAL] I'm sorry? [CUSTOMER][NEUTRAL] Relation with the subscriber. [AGENT][NEUTRAL] We don't have all that information. That's just the the policyholder and one of their dependents, so they could be a parent or guardian, it's it's one of their dependents. [CUSTOMER][NEUTRAL] Mm [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] Mhm. OK. Uh, date of birth of the policy holder, please. [AGENT][NEUTRAL] We don't usually give all this information to the provider. Do you not have that? [CUSTOMER][POSITIVE] OK, no issue. [CUSTOMER][NEUTRAL] And may I get the call reference number for this call? [AGENT][NEUTRAL] There's no call reference number, but you can use my name and today's date. The first initial to my last name is [PII]. [CUSTOMER][POSITIVE] Mhm. Thank you so much for this information. Have a great day ahead. [AGENT][POSITIVE] You also, and thanks for calling APL. Is there anything else I could assist you with? [CUSTOMER][NEUTRAL] You. [CUSTOMER][NEUTRAL] OK. Give me a moment, then if I do have another claim with me, I'll go with that. If not, I'll end up with this call, OK? [AGENT][NEUTRAL] OK. [CUSTOMER][NEUTRAL] OK. I do have another claim with me. [AGENT][NEUTRAL] Is it the same member or different member? [CUSTOMER][NEUTRAL] Different. [CUSTOMER][NEUTRAL] We [AGENT][NEUTRAL] OK, hold on one moment, let me note this policy. [CUSTOMER][NEUTRAL] Oh [CUSTOMER][NEUTRAL] It [CUSTOMER][NEUTRAL] I [AGENT][NEUTRAL] OK. And the next member's policy number? [CUSTOMER][NEUTRAL] Mhm [CUSTOMER][NEUTRAL] G as in Golf 0801. [AGENT][NEUTRAL] OK, that's not an APL policy number. [CUSTOMER][NEUTRAL] Give me a moment. [AGENT][NEUTRAL] OK. [CUSTOMER][NEUTRAL] OK. 02489440. [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] OK. [CUSTOMER][NEUTRAL] She. Last name is [PII]. Date of birth is [PII]. [AGENT][NEUTRAL] Thank you for that. Again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service for the claim? [CUSTOMER][NEUTRAL] [PII]. [AGENT][NEUTRAL] And the total bill amount? [CUSTOMER][NEUTRAL] 25,135 cents even. [AGENT][NEUTRAL] $25,135. [CUSTOMER][NEUTRAL] Yeah. [CUSTOMER][NEUTRAL] Yes. [AGENT][NEUTRAL] Hold on one moment. [AGENT][NEUTRAL] And what is the name of the provider on this claim? [CUSTOMER][NEUTRAL] He's a Florida Northwest Hospital. [AGENT][NEUTRAL] Alright, I'm showing we received the claim on [PII]. [AGENT][NEUTRAL] The claim number is 356. [CUSTOMER][NEGATIVE] Dead on. [AGENT][NEUTRAL] Would you like the claim number? [CUSTOMER][NEUTRAL] Sorry, OK. [CUSTOMER][NEUTRAL] Yes, yes. [AGENT][NEUTRAL] The claim number is 3562843. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] And on [PII], the claim was denied. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] OK. [AGENT][NEUTRAL] Requesting the explanation of benefits from primary insurance. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] OK. Previously twice we have sent the primary OB, so did you receive it or not? [AGENT][NEUTRAL] On what day did you send them? [CUSTOMER][NEUTRAL] Yeah [CUSTOMER][NEUTRAL] Hm [CUSTOMER][NEUTRAL] Give me a moment it will send on. [CUSTOMER][NEUTRAL] [PII]. [AGENT][NEUTRAL] Was it mailed? [CUSTOMER][NEUTRAL] Uh, uh, give me a moment. I need to look on it, how they have sent. [CUSTOMER][NEUTRAL] Yes, mailing address will be [PII]. [AGENT][NEGATIVE] Well, it's only been 3 days, so it probably has not been received yet. Where is it coming from? [CUSTOMER][POSITIVE] And yes, timely filing is. [CUSTOMER][NEUTRAL] Mhm [CUSTOMER][NEUTRAL] Oh, OK. So it will take some time, right? [AGENT][NEUTRAL] Right, depending on where it's coming from, yeah. OK. [CUSTOMER][NEUTRAL] And may I know your facts? [AGENT][NEUTRAL] Your fax number is 877. [CUSTOMER][NEUTRAL] Fax number, please. [AGENT][NEUTRAL] 365 [CUSTOMER][NEUTRAL] Uh-huh. [AGENT][NEUTRAL] 942 3. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] OK. Uh, timely filing to submit this primary OB? [AGENT][NEGATIVE] There's no timely filing as long as the policy was active on the data service. [CUSTOMER][POSITIVE] OK. Thank you so much. Uh, I can pull another claim with your permission if not. [AGENT][NEUTRAL] Hold on one moment, let me note this policy. [CUSTOMER][NEUTRAL] I don't know about this call. [CUSTOMER][NEUTRAL] Mhm. You are on hold. [AGENT][NEUTRAL] [PII], OK, wait a minute, um. [AGENT][NEUTRAL] The number. [CUSTOMER][NEGATIVE] You are on hold. [AGENT][NEUTRAL] OK, hello [PII]. [CUSTOMER][NEUTRAL] Yes, please. [AGENT][NEUTRAL] Thank you for holding and what is the next member's policy number? [CUSTOMER][NEUTRAL] Yes, give me a moment. Um, I'm just looking on it. [CUSTOMER][NEUTRAL] The [CUSTOMER][NEUTRAL] Yeah [CUSTOMER][NEUTRAL] Deepwater. [CUSTOMER][NEUTRAL] OK, I'm with the another claim. [CUSTOMER][NEUTRAL] So [CUSTOMER][NEUTRAL] I can give you the policy ID with me. [AGENT][NEUTRAL] OK. [CUSTOMER][NEUTRAL] 024622 V. 6 M as in Mike. L as in Lima number 8. [AGENT][NEUTRAL] OK, hold on one moment. [AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth? [CUSTOMER][NEUTRAL] It is [PII], [PII], sorry, [PII]. [AGENT][NEUTRAL] And you said the policy number is 02462286? [AGENT][NEUTRAL] Is that correct? [CUSTOMER][POSITIVE] Yes, exactly. [AGENT][NEUTRAL] OK, that's bringing up a, that's bringing up a different member. [CUSTOMER][NEUTRAL] Yes, yes. [CUSTOMER][NEUTRAL] Mm give me a moment. We do have the. [CUSTOMER][NEUTRAL] You will be with us with the claim number? [AGENT][NEUTRAL] OK, what's the claim number? [CUSTOMER][NEUTRAL] 3558928 [AGENT][NEUTRAL] OK, hold on one moment. [CUSTOMER][NEUTRAL] OK [CUSTOMER][NEUTRAL] Yeah [CUSTOMER][NEUTRAL] a [AGENT][NEUTRAL] OK, the last number is a 36, not 86. Hold on one second. [AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth? Uh, it was a different policy last time, my apologies. [CUSTOMER][NEUTRAL] She did not [AGENT][NEUTRAL] Can you repeat the member's date of birth for me, please? [CUSTOMER][NEUTRAL] Yes. [CUSTOMER][NEUTRAL] 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. May I have, well, hold on one moment. [AGENT][NEUTRAL] And so you have the claim number. Did you have a particular question about the claim? [CUSTOMER][NEUTRAL] Uh, actually, yes. [AGENT][NEUTRAL] OK. [CUSTOMER][NEUTRAL] Uh, you were asking about the primary you actually we sent it on the same [PII]. Did you receive it via fax we have sent. [AGENT][NEUTRAL] You sent it on what day? [AGENT][NEUTRAL] I didn't hear, I didn't hear you. [CUSTOMER][NEUTRAL] On [PII]. [CUSTOMER][NEUTRAL] [PII]. [AGENT][NEGATIVE] Right, if you mailed it, it hasn't been enough time for it to get here. [CUSTOMER][NEUTRAL] Facts, facts. [AGENT][NEUTRAL] Our fax number is [PII]. [CUSTOMER][NEUTRAL] I [AGENT][NEUTRAL] [PII]. [CUSTOMER][NEUTRAL] Already we have sent [CUSTOMER][NEUTRAL] Sorry to disturb and uh already we have. [AGENT][NEUTRAL] You're saying you faxed it? [CUSTOMER][NEUTRAL] Yes. [AGENT][NEUTRAL] OK, hold on one moment. [AGENT][NEUTRAL] Let me see if this is it. Hold on one second. [AGENT][NEUTRAL] So we haven't received the fax yet. Um, hold on one moment. [AGENT][NEGATIVE] I just want to double check, but no, we haven't received it. [CUSTOMER][NEUTRAL] Sure. [CUSTOMER][NEUTRAL] OK, no issue. When did you receive this claim? [AGENT][NEUTRAL] It was received on [PII]. [CUSTOMER][NEUTRAL] [PII] add ons. [AGENT][NEUTRAL] [PII]. [CUSTOMER][NEUTRAL] On [CUSTOMER][NEUTRAL] OK. I do have the fax number, so we'll just fax to that, OK? [CUSTOMER][POSITIVE] And uh I'm just set up end up in with this call, OK? Thank you so much for this information. [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] Alright, is there anything else I can assist you with today? [CUSTOMER][NEUTRAL] So I need to pull another claim or how it will be? [AGENT][NEUTRAL] Uh, that's up to you. Do you have more claims? [CUSTOMER][NEUTRAL] Give me a moment then. [CUSTOMER][NEUTRAL] Uh yes, I do have another 2 claims with me. Give me a moment. I'm just pull upping with that, OK? [AGENT][NEUTRAL] OK. [CUSTOMER][NEUTRAL] Yes, I do have the another number. [AGENT][NEUTRAL] OK, hold on one moment, let me note this policy and then we can move on to the next one. [CUSTOMER][NEUTRAL] Sure. [AGENT][NEUTRAL] OK, the next member's policy number? [CUSTOMER][NEUTRAL] OK, it is. [CUSTOMER][NEUTRAL] 0249 02497688. [CUSTOMER][NEUTRAL] That [AGENT][NEUTRAL] Thank you, hold on one moment. [CUSTOMER][NEUTRAL] [PII]. [AGENT][NEUTRAL] And the date of birth? [CUSTOMER][NEUTRAL] Date of birth. [CUSTOMER][NEUTRAL] [PII]. [AGENT][NEUTRAL] And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service for the claim and the total bill? [AGENT][NEUTRAL] Hello. [CUSTOMER][NEUTRAL] Sorry, it is. [CUSTOMER][NEUTRAL] [PII], but the amount was $1,538 even. [AGENT][NEUTRAL] Thank you, hold on one moment. [AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim? [CUSTOMER][NEUTRAL] It is [CUSTOMER][NEUTRAL] Allegan Regional Hospital. [AGENT][NEUTRAL] What's the tax ID? [CUSTOMER][NEUTRAL] [PII] [AGENT][NEUTRAL] OK. [CUSTOMER][NEUTRAL] Mhm [AGENT][NEUTRAL] So I'm showing we received the claim on [PII]. [CUSTOMER][NEUTRAL] Yeah [AGENT][NEUTRAL] The claim number is 355. [AGENT][NEUTRAL] 9652. [AGENT][NEUTRAL] And on [PII], the claim was denied. [AGENT][NEUTRAL] Because the services were rendered after coverage was terminated. [AGENT][NEUTRAL] The policy was active. [AGENT][NEUTRAL] From [PII]. [CUSTOMER][NEUTRAL] Yeah [CUSTOMER][NEUTRAL] OK. Member is ineligible for the date of service. [AGENT][POSITIVE] Correct. [CUSTOMER][NEUTRAL] Is there any active policy with that number? [AGENT][NEUTRAL] Not with APL. [CUSTOMER][POSITIVE] OK. Thank you so much for this information. [CUSTOMER][NEUTRAL] I [AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today? [CUSTOMER][NEUTRAL] And only the one last account I do have with me. So give me a moment. I'm just pull up with that account, OK? [AGENT][NEUTRAL] OK. [CUSTOMER][NEUTRAL] So [CUSTOMER][NEUTRAL] I [CUSTOMER][NEUTRAL] How long this [CUSTOMER][NEUTRAL] I [CUSTOMER][NEUTRAL] OK. I do have a different policy ID with me. [AGENT][NEUTRAL] OK. [CUSTOMER][NEUTRAL] And it is 226-745-5. [AGENT][NEUTRAL] All right, hold on one moment. [AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth? [CUSTOMER][NEUTRAL] Yeah. [CUSTOMER][NEUTRAL] OK. OK, ma'am. My first name is [CUSTOMER][NEUTRAL] [PII]. Last name is [PII]. Date of birth is. [CUSTOMER][NEUTRAL] [PII]. [AGENT][NEUTRAL] Thank you for that. And again, just for the call, 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? [CUSTOMER][NEUTRAL] [PII]. [AGENT][NEUTRAL] And the total bill amount? [CUSTOMER][NEUTRAL] $10,0024.79. [AGENT][NEUTRAL] Thank you, hold on one moment. [AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim? [CUSTOMER][NEUTRAL] Medical City, Arlion. [CUSTOMER][NEUTRAL] I on [AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII]. [AGENT][NEUTRAL] The claim number is 354. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] 5885. [AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] OK, so give me a moment previously on. [CUSTOMER][NEUTRAL] [PII], we have sent it. So, did you receive that not? And give me a moment, how we have sent, I'll just let you know. [AGENT][NEUTRAL] What's that? OK. [CUSTOMER][NEUTRAL] I sent it. [CUSTOMER][NEUTRAL] Through fax. [AGENT][NEUTRAL] So it was received on [PII]. [AGENT][NEUTRAL] The claim number is 357. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] 9610. [AGENT][NEUTRAL] And on [PII], the claim was paid to the provider, $2,621.04. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] Give me a moment. When did you receive this? [CUSTOMER][NEUTRAL] Uh, primary you'll be received on? [AGENT][NEUTRAL] Hold on one moment. [CUSTOMER][NEUTRAL] [PII], right? [AGENT][POSITIVE] Correct. [CUSTOMER][NEUTRAL] OK. Give me a moment. And it got paid with the claim number you have provided. Paid amount was, OK. So what was the allowed amount? [AGENT][NEUTRAL] Hold on one moment. [AGENT][NEUTRAL] So the [AGENT][NEUTRAL] I guess we could say the allowed amount, the benefit is $6000 per calendar year. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] What was billed to us was $2,621.04 and that's what we paid. [CUSTOMER][NEUTRAL] OK, for this number? [CUSTOMER][NEUTRAL] 00, OK. So can you please send the primary, not primary OB, uh, that PDUB via fax. I can provide you the number. [AGENT][NEUTRAL] Yes, what's a good fax number for you? [CUSTOMER][NEUTRAL] [PII] [AGENT][NEUTRAL] OK, do I need to put attention, [PII]? [CUSTOMER][NEUTRAL] Yes. [AGENT][NEUTRAL] And that was [PII]? [CUSTOMER][POSITIVE] Exactly. [AGENT][NEUTRAL] OK. [CUSTOMER][NEUTRAL] Yes. [AGENT][POSITIVE] So I'll go ahead and send the explanation of benefits over to you now. Was there anything else I can assist you with today? [CUSTOMER][NEUTRAL] And how much time it will take uh to send via fax? [AGENT][POSITIVE] Well, we usually give faxes at least an hour. Um, if you haven't received it by end of day today, you can give us a call back and we'll be more than happy to resend it for you. [CUSTOMER][POSITIVE] OK. Thank you so much for this information. Have a great day ahead. [AGENT][POSITIVE] You also, and thanks for calling APL. Bye-bye.