AccountId: 011433970860
ContactId: 475586ec-ebab-4f9e-bf70-8547e4533e76
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352410 ms
Total Talk Time (AGENT): 140536 ms
Total Talk Time (CUSTOMER): 110047 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/475586ec-ebab-4f9e-bf70-8547e4533e76_20250304T13:49_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, this is [PII] calling from provider's office to check on the denial of the claim.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim denial, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, that is [PII].
[CUSTOMER][NEUTRAL] [PII]. That's a direct line, no extension.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is 2272854.
[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] Yes, the patient first name is [PII].
[CUSTOMER][NEUTRAL] And last name is [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 for the claim you want me to check on?
[CUSTOMER][NEUTRAL] Yes, that is [PII].
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] Total bill amount is
[CUSTOMER][NEUTRAL] 3000, uh, wait a minute.
[CUSTOMER][NEUTRAL] Yeah, it is $70,536 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So is there any other, so the date range on this?
[AGENT][NEUTRAL] Oh, I was thinking the [PII]. OK, this is correct. Hold on one moment.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] HA Florida Kindle Hospital.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] Claim number is 355.
[AGENT][NEUTRAL] 4596.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Yes, sir. Did you receive any of primary UB?
[AGENT][NEUTRAL] With the claim that was denied or after?
[CUSTOMER][NEUTRAL] No. Did you receive any primary UB from our end?
[AGENT][NEUTRAL] I'm asking, are, are you asking me if we receive the explanation of benefits with this denied claim or are you saying you sent it after the claim was denied?
[CUSTOMER][NEUTRAL] After the claim was denied.
[AGENT][NEUTRAL] OK, well, no, we haven't received anything outside of this um claim yet. When did you, did, when did you send it?
[CUSTOMER][NEUTRAL] That is on [PII].
[AGENT][NEUTRAL] And it was, was it mailed or how was it sent to us?
[CUSTOMER][NEUTRAL] It is mailed through [PII].
[AGENT][NEUTRAL] OK, well, it's only been a week and you sent it US mail, so, um, I would, I mean, you can give it a little more time or you can send it electronically or fax it to us.
[CUSTOMER][NEUTRAL] OK. What is the time for waiting or review?
[AGENT][NEUTRAL] The turnaround time is 7 to 10 business days.
[CUSTOMER][NEUTRAL] 7 to 10 business days.
[AGENT][NEUTRAL] To process the claim you're asking, right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so, after that, we can call, right? So that we can get the clarity about the claim.
[AGENT][NEUTRAL] It's 7 to 10 business days from when we received the claim, but we haven't received the claim yet.
[CUSTOMER][NEUTRAL] So you, uh, we should wait for review or we have to send again?
[AGENT][NEUTRAL] That's up to you. Um, you can like, um, as advised, you can either see if this comes, the one that was mailed, or you can fax it or um send it electronically to us.
[CUSTOMER][NEUTRAL] OK. May I get the fax number?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's attention APL claims department.
[CUSTOMER][NEUTRAL] Uh, could you please repeat the number again?
[AGENT][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Mm, no. May I get the
[CUSTOMER][NEUTRAL] Call difference?
[AGENT][NEUTRAL] Sure, sir, there's no call reference number, but you can use my name in today's date.
[AGENT][NEUTRAL] The first initial to my last name is [PII], my first name is [PII]
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Thank you so much for your time and assistance. Have a great day. Bye.
[AGENT][POSITIVE] You also and thanks for calling APO bye bye.