AccountId: 011433970860
ContactId: 58bfb474-89b2-4465-9c39-85154b39787e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 433589 ms
Total Talk Time (AGENT): 72159 ms
Total Talk Time (CUSTOMER): 231861 ms
Interruptions: 2
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/58bfb474-89b2-4465-9c39-85154b39787e_20250620T12:29_UTC.wav
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[AGENT][NEUTRAL] APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from providers. So please check on the claim status. Can you please help me with that?
[AGENT][NEUTRAL] Mm, I'm happy to check on a claim this morning. What's the policy number?
[CUSTOMER][NEUTRAL] Check on a claim this morning. What's the policy number? It's 02560355.
[AGENT][NEUTRAL] Thank you and do you have a good callback number for documentation?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh yes, I have. It's [PII], a direct line.
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yes, patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] The date of service is [PII] for the bill amount, $4,756 even.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] They think
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Do you by chance have a uh different amount after primary paid?
[CUSTOMER][NEUTRAL] Of a uh different amount after primary.
[CUSTOMER][NEUTRAL] Uh, yes, so the primary process, uh, $124.90 towards deductible. So originally we have the APL with the balance amount of $12419 which got paid. Then, uh, the PCPS, the primary payer, reprocessed the claim.
[CUSTOMER][NEUTRAL] Um, with a deductible of $260.82 and co-insurance of $349.07 $349.07. So the total, so the total responsibility of $609.89. So we have resubmitted the claim to FPL on [PII] which got denied the ticket.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so the previous representative we met call on [PII] requested us to resubmit the current claim, so we have uh resubmitted the current claim with the balance amount. After the primary paid the balance amount of $609.89 and the claim was rested on [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Sorry
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Get
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, and because we, we cook.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Maybe
[AGENT][NEUTRAL] 1
[CUSTOMER][NEUTRAL] or something.
[AGENT][NEGATIVE] Yeah, I'm not seeing anything for $609 that was resubmitted.
[CUSTOMER][NEUTRAL] $9.
[AGENT][NEUTRAL] Or the 260 or 349.
[CUSTOMER][NEUTRAL] For the 260 or 3409. Uh.
[CUSTOMER][NEUTRAL] Uh, yes, so the same thing the previous representative stated on [PII].
[CUSTOMER][NEUTRAL] Uh, stating there is no claim on file for $609.89. And so we have resubmitted the claim on [PII] to address [PII].
[AGENT][NEUTRAL] That is the correct address. I don't see anything in here. Do you want the fax number? You wanna try it that way?
[CUSTOMER][NEUTRAL] But that's the correct address. I don't.
[CUSTOMER][NEUTRAL] You want.
[CUSTOMER][POSITIVE] Uh, yeah, sure. I can do that.
[AGENT][NEUTRAL] Fax number is [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 43. All right. And may I know the attention too?
[AGENT][NEUTRAL] Uh, claims
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Please
[CUSTOMER][NEUTRAL] Claims. All right. OK, thank you so much. And may I know the timely filing limit?
[CUSTOMER][NEUTRAL] Or claim submission.
[AGENT][NEUTRAL] There's
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] All right, thank you so much. And to make sure the member is active during the date of service, can you please provide me the member coverage effective and termination date?
[AGENT][POSITIVE] Absolutely. So effective date is [PII]. Patient is still active.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] All right. All right. OK. Thank you so much, [PII], for the information and assistance. It was a great help. And can you please provide me a call reference number?
[AGENT][NEUTRAL] Call reference is my name with today's date. My name again is [PII], that's [PII], last initial [PII], and then today's date.
[CUSTOMER][NEUTRAL] Reference is my name.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] All right. OK. Thank you so much, [PII], for the information. It was a great help and have a wonderful day.
[AGENT][NEUTRAL] You as well. Bye-bye.