AccountId: 011433970860
ContactId: 4fe2610a-0b2c-4a77-a2b7-833c02a1dae1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 583390 ms
Total Talk Time (AGENT): 171298 ms
Total Talk Time (CUSTOMER): 137382 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/4fe2610a-0b2c-4a77-a2b7-833c02a1dae1_20250305T14:18_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] Hey [PII], it's [PII] with Broker Resources. How are you?
[AGENT][POSITIVE] Hey, I'm doing good how are you?
[CUSTOMER][NEUTRAL] I'm good. OK, I have somebody on the line he's needing claims help.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And my uh lion is not being very nice to me, so I'm still trying to pull up, hold on just a second, I'm still trying to get information. Um I can't really understand him that well, but I think.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 516121 is the policy number. It's not what he originally gave me but.
[AGENT][NEUTRAL] You said 516121?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, his name is [PII].
[CUSTOMER][NEUTRAL] And he said it was for [PII].
[AGENT][NEUTRAL] OK, yes.
[CUSTOMER][POSITIVE] OK, um, I'm gonna join you guys now thank you.
[AGENT][POSITIVE] All right, you're welcome.
[CUSTOMER][NEUTRAL] [PII], are you still with me?
[CUSTOMER][POSITIVE] Yes. I have claims on the line for you.
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I have claims on the line for you.
[AGENT][NEUTRAL] Hi [PII], how are you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, hi, I'm fine. How about you?
[AGENT][NEUTRAL] I'm doing well. Um, so you have questions in reference to a claim for [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what is your relation to the patient?
[CUSTOMER][NEUTRAL] I'm, I'm from the provider's office. I'm not related to the patient. Yes.
[AGENT][NEUTRAL] Oh, you're the provider.
[AGENT][NEUTRAL] OK. Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, just a second.
[CUSTOMER][NEUTRAL] Uh, member ID is 0247326 M as in Mike, L as in Lima, 8.
[CUSTOMER][NEUTRAL] The date of birth, uh, date of birth goes as uh [PII].
[AGENT][NEUTRAL] Well, hold on one second.
[AGENT][NEUTRAL] This is a different policy.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You said the policy number was 0247326?
[CUSTOMER][NEUTRAL] 326, M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] There's a number missing. Can you repeat that policy number?
[CUSTOMER][NEUTRAL] 0247
[CUSTOMER][NEUTRAL] 326 ML 8.
[AGENT][NEUTRAL] Yeah, there's a, there's a number missing. Do you have the member's um social?
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, let me try with the name.
[AGENT][NEUTRAL] So the policy number that you provided is missing a number. I'm going to try to locate it with her first and last name. You said you don't have the member's social?
[CUSTOMER][NEUTRAL] Oh, yeah.
[CUSTOMER][NEUTRAL] I don't have the uh social security number.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I don't, uh, we don't have the social security number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said her first name is [PII], correct? Is there a middle initial?
[CUSTOMER][NEUTRAL] Yes. [PII].
[AGENT][NEUTRAL] Right. Is there a middle initial?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Does the member have a middle initial?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So we only have one policy for [PII], but the member has a different date of birth than the date of birth that you provided. Do you have a copy of the ID card or the claim number?
[CUSTOMER][NEUTRAL] Just give me a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Actually, we do have uh insurance copy.
[AGENT][NEUTRAL] OK, on the card, do you see the in-hospital or outpatient policy certification number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes. It's [PII].
[AGENT][NEUTRAL] OK, so it's missing a 4. Hold on one moment.
[AGENT][NEUTRAL] And can you verify, oh well, we already verified her.
[AGENT][NEUTRAL] OK, and may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] And the total bill?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Uh, $457 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] 457.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's Holy Cross Hospital.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 0519.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting an explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Uh do you need first?
[AGENT][NEUTRAL] Denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Just hold on a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Uh, can I get the date, uh, on which day the card, uh, was recently updated?
[AGENT][NEUTRAL] I'm sorry, can you repeat that slowly?
[CUSTOMER][NEUTRAL] Uh, when was the last, the cop, uh, cop was updated, copy information?
[AGENT][NEUTRAL] When was the last I don't understand.
[AGENT][NEUTRAL] What
[CUSTOMER][NEUTRAL] Uh, when was the last the co information was updated?
[AGENT][NEUTRAL] When was the last time the coordination of benefits was updated?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] This is a secondary policy, so this is the only coordination of benefits is the primary that it's to. This is secondary to, hold on one moment.
[AGENT][NEUTRAL] This is secondary to Florida Blue.
[AGENT][NEUTRAL] So that's the only coordination of benefits. This policy is only second to Florida Blue.
[AGENT][NEUTRAL] We pay towards the copay, deductible and co-insurance after primary.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Can I get the, uh, can I get your name, please?
[AGENT][NEUTRAL] Sure, my name is [PII] The [PII] my [PII] name is [PII].
[CUSTOMER][NEUTRAL] [PII] and the last name is [PII]
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] OK. Uh, can I get the call number, please?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date.
[CUSTOMER][POSITIVE] OK. Sure, [PII]. Uh, thanks for your uh information. Have a nice day.
[AGENT][POSITIVE] You're very welcome. Thanks for calling APL.