AccountId: 011433970860
ContactId: 54879997-1937-4e61-8e8f-75f0611eb370
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 686609 ms
Total Talk Time (AGENT): 271085 ms
Total Talk Time (CUSTOMER): 279656 ms
Interruptions: 6
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/54879997-1937-4e61-8e8f-75f0611eb370_20250106T18:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office to check on the claim status. And before we proceed, I would like to inform you this call is being recorded for quality and training purposes. Is that OK with you?
[AGENT][NEUTRAL] Yeah, I could check on a claim for you [PII]. Alright, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, thank you, and then do you have the policy number?
[CUSTOMER][NEUTRAL] It's 02266017. M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, thank you and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] It's uh [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII] and what was the date of service for this client, please?
[CUSTOMER][NEUTRAL] [PII] total bill amount $850 even 850.
[AGENT][NEUTRAL] OK, got it. That was [PII].
[CUSTOMER][NEUTRAL] Yes, and for this one, actually I have a specific question, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Uh, so just click OK.
[AGENT][NEUTRAL] Oh, go ahead, go ahead. I'm sorry.
[CUSTOMER][NEUTRAL] And actually the claim was denied for primary EUB. So a copy of primary OB was submitted on [PII]. So I need the status for the EUB and also I didn't catch your name, so could you just spell out your name for me once?
[AGENT][NEUTRAL] Sure, it's [PII]
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Uh, yes, of course, and let's see.
[AGENT][NEUTRAL] Bear with me just a moment. The policy number you gave me, uh, terminated [PII], so I'm trying to find the policy that was active during that time. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, and was the 850, was that the amount before major medical paid?
[CUSTOMER][NEUTRAL] Yes, no, no, ah, before the what you said.
[AGENT][NEUTRAL] Uh, before their primary paid, their major medical.
[CUSTOMER][NEUTRAL] Yes, yes, 80.
[AGENT][NEUTRAL] It is before do you have the amount uh the remaining balance by chance?
[CUSTOMER][NEUTRAL] The remaining balance is $492.77.
[AGENT][POSITIVE] Got it. OK, thank you for that. All right, bear with me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm sorry, what was the name of the provider's office?
[CUSTOMER][NEUTRAL] Vital MD Group Holding LLC.
[AGENT][NEUTRAL] Do you happen to have the tax ID?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, OK, I've got it as diagnostic center of Miami. Give me just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I did find that original claim number. I'm not um yeah, the original claim number, um, I don't see that we have received that EOB, but I'm going to check to see if it might have gone to that other policy number that you gave me, cause if it did, it might need to be resubmitted to the correct policy number. Bear with me just one moment.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, so you, you did not receive any copy of UB?
[AGENT][NEUTRAL] Not for the this policy number that it should have been submitted to, but I'm going to check the other one, the first one that you mentioned to see if it might have gone to that one by mistake. Give me just a moment.
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, no, it didn't go to that one either, so before we go any further, let me give you this correct policy number. This one was active at that time, that date of service let me know when you're ready for that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] OK, it is 0241.
[AGENT][NEUTRAL] 9335.
[CUSTOMER][NEUTRAL] That's the policy number?
[AGENT][NEUTRAL] Yes, this one was effective from [PII].
[CUSTOMER][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] Uh, provide me the fax number to submit the UB.
[AGENT][NEUTRAL] Of course, it is 877.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much for that one. And I have a few more members to check on. So with how many members can you help me?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Could you repeat that, [PII]? I'm sorry.
[CUSTOMER][NEUTRAL] I said I have 2 more members to check after this one. Can you help me with those 2 also?
[AGENT][NEUTRAL] They are different members.
[CUSTOMER][NEUTRAL] Yes, but under the same facility.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Under the same policy, oh, OK, let's see.
[CUSTOMER][NEUTRAL] No, the same facility, the same facility.
[AGENT][NEUTRAL] Oh facility OK I see alright, yes, give me just a moment I'll let you know when I'm ready for that next one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, file.
[AGENT][NEUTRAL] OK, I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] 02419355
[AGENT][NEUTRAL] OK, and what was the native name and date of birth for this insured?
[CUSTOMER][NEUTRAL] It is [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] Thank you and what was the date of service for this one, please?
[CUSTOMER][NEUTRAL] [PII] with the total bill amount of $500 even.
[AGENT][NEUTRAL] OK, [PII] you said?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] OK, got it thank you one moment.
[CUSTOMER][NEUTRAL] And for this one also, actually, uh, the claim was sent for primary UB and copy of primary UB was submitted on [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] As you open.
[AGENT][NEUTRAL] Was this, I'm sorry, this was a diagnostic center for women is that the provider?
[CUSTOMER][POSITIVE] Yes, yes, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. I think I found it, um.
[AGENT][NEUTRAL] Was the remaining benefit amount was it $286.91?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK awesome yes so I did we did receive that claim and that EOB um we did pay that benefit of $286.91. Um, did you need that claim number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, it is 3541181.
[CUSTOMER][NEUTRAL] And the payment details?
[AGENT][NEUTRAL] Give me one moment, I'm getting that check number.
[CUSTOMER][NEUTRAL] asking.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so that check number is 2018614.
[CUSTOMER][NEUTRAL] And when was the strict paid?
[AGENT][NEUTRAL] Check was issued [PII].
[CUSTOMER][NEUTRAL] You're gonna.
[AGENT][NEUTRAL] Single check of $286.91 and I am showing it has not yet cleared.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So once it reaches that um 30 day mark from the issue date if you still have not received it, you can reach out to us we will void this one and reissue a new check.
[CUSTOMER][NEUTRAL] OK, no problem. And just allow me a moment to pull up that next number in my system.
[AGENT][POSITIVE] Of course, yes, give me just a moment as well, please.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] OK, [PII], are you ready for the next member ID?
[AGENT][NEUTRAL] Uh, one moment please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I am ready for that. Nex policy number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 01663521 M as in Mary, L as in Lima number 8.
[AGENT][NEUTRAL] OK, and the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for that and then what was the date of service for this one?
[CUSTOMER][NEUTRAL] [PII] total bill amount $3500 even.
[CUSTOMER][NEUTRAL] And for this and also the same scenario and UB was submitted on [PII].
[AGENT][NEUTRAL] OK, got it one moment please.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, uh, for this one, let's see.
[AGENT][NEUTRAL] 011. Give me just a moment.
[CUSTOMER][NEUTRAL] We have both.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh, you can do that.
[AGENT][NEUTRAL] OK, so I'm not showing that we received the EOB for this one, [PII]. I do have that.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Um, was it Pembroke Pink Imaging?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yeah, so I do see the original claim, um, but I'm not showing that we received anything.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, after this.
[CUSTOMER][NEGATIVE] On [PII], you did not receive any UV.
[AGENT][NEGATIVE] Correct, we did not.
[CUSTOMER][NEUTRAL] No problem. So provide me the claim number then.
[AGENT][NEUTRAL] Yes, claim number is 3511.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 329.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] No problem. Thank you so much, [PII], for your assistance and you were really helpful. Have a great day ahead. Bye-bye. Take care.
[AGENT][NEUTRAL] Yeah, was there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's all thank you so much.
[AGENT][POSITIVE] Alright, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye.