AccountId: 011433970860
ContactId: 5a245609-565c-497a-bf3e-ed461d651e56
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 856419 ms
Total Talk Time (AGENT): 268468 ms
Total Talk Time (CUSTOMER): 166588 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/5a245609-565c-497a-bf3e-ed461d651e56_20250619T15:12_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]. I'm calling from provider office. I have two claims where we had billed the claim, but we didn't receive any EOP, so can you please check and let me know.
[AGENT][NEUTRAL] OK, [PII], so you have 2 different claims that you're needing to find out about getting an explanation of benefits for, is that correct?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][POSITIVE] Yes, I can help you with that.
[CUSTOMER][NEUTRAL] I tried to log in on the APL website.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] But it's asking me uh email address which I don't have. I just have a user ID and password.
[CUSTOMER][NEGATIVE] But I don't understand how to log in.
[CUSTOMER][NEUTRAL] With user ID and password.
[AGENT][NEUTRAL] OK, I can try and help you with that also and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][NEUTRAL] Thank you. And are the, are the two claims for the same patient or are they two different policies, two different patients?
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] Yeah, two different patients, but.
[CUSTOMER][NEUTRAL] Facilities the emergency medicine services of Florida.
[AGENT][NEUTRAL] OK, what is the first, OK, so any information that I provide for you, [PII] will be a verification of benefits and not a guarantee of payment. And also if you need a copy, I'm sorry, if you need a reference number for our call today, you will use my name that I gave you along with today's date.
[AGENT][NEUTRAL] So, first off,
[CUSTOMER][NEUTRAL] And his spell it?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] is the first letter of my first name.
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] You're welcome. And what is your first patient's policy number?
[CUSTOMER][NEUTRAL] That is 14.
[CUSTOMER][NEUTRAL] 35
[CUSTOMER][NEUTRAL] 24 M as in Mary L as in Lima 7.
[AGENT][NEUTRAL] OK, so we're missing a number there. I heard you say 143524.
[AGENT][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] There is the first part of the number?
[CUSTOMER][NEUTRAL] 1451435242. M as in Mary, L as in Lima 7.
[AGENT][NEUTRAL] Yes
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] OK, and what is your patient's name and date of birth on this policy?
[CUSTOMER][NEUTRAL] [PII] Date of birth [PII].
[AGENT][NEUTRAL] OK, so now this policy is an old policy that termed back in [PII]. What is the data service that you're calling about on this number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] And total bill amount?
[CUSTOMER][NEUTRAL] $678 even?
[AGENT][NEUTRAL] OK, so first off, [PII], on this policy there is no claim with that policy because this again this policy was not active for your data service so let me see.
[CUSTOMER][NEUTRAL] Till when this date of service uh till when this, uh, member ID was active.
[AGENT][NEUTRAL] That, that policy number you gave me had an effective date of [PII]. I'm going to provide you the correct policy number that you should have. One moment.
[AGENT][NEUTRAL] So the current policy number is.
[AGENT][NEUTRAL] 02566928. This policy is active with no term date and the effective date is [PII].
[CUSTOMER][NEUTRAL] And what is the timely filing to resubmit the claim?
[AGENT][NEUTRAL] There is no timely filing limit, but give me a moment to see if we received the claim and processed it under the correct policy number, so just a moment.
[CUSTOMER][NEUTRAL] We had mailed that claim on mailing address of [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that's also an old.
[CUSTOMER][NEUTRAL] Is that the correct address?
[AGENT][NEUTRAL] It used to be, but it has not been our correct mailing address for quite some time now. So I will provide you that information as well, but give me just a moment please, [PII], OK?
[CUSTOMER][NEUTRAL] Bye
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so no we do not have a claim on file.
[AGENT][NEUTRAL] Um, for her for that data service, so the correct mailing address that you would need is [PII].
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] City, [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] The state is [PII] and the zip code is [PII].
[CUSTOMER][NEUTRAL] I got it.
[AGENT][NEUTRAL] And we will have to have a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I will refile the claim along with the primary EOB attached.
[AGENT][NEUTRAL] That is correct to that address that I gave to you.
[CUSTOMER][NEUTRAL] Let me give you
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me give you the last time.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Ma'am, please hold the line, OK? Let me pull up the claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, sir. I'm still here.
[CUSTOMER][POSITIVE] Sorry for the long
[CUSTOMER][NEUTRAL] The new member ID is 0236.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 1622
[AGENT][NEUTRAL] [PII], uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the data service and total bill amount, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Billed amount is 678.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, so this claim was received. The received date was [PII].
[AGENT][NEGATIVE] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] 2600.
[CUSTOMER][NEUTRAL] So what about the claim?
[AGENT][NEUTRAL] What, what is your question, [PII]?
[CUSTOMER][NEUTRAL] What about new claim which was received in the month of April?
[AGENT][NEUTRAL] I'm sorry, I, I, I'm still not understanding. We did receive this claim for this member?
[CUSTOMER][NEUTRAL] Ma'am, we have sent that that claim was denied for a primary EOB, so we have sent another claim.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] On in the month of April.
[AGENT][NEUTRAL] OK, we did not receive that.
[CUSTOMER][NEUTRAL] And last time my colleague has called and he informed that.
[AGENT][NEUTRAL] Yes, we have not received another claim for this member for this data service and that billed out. This is the only claim on file.
[CUSTOMER][NEUTRAL] Oh, is that possible? My colleague has called and he.
[CUSTOMER][NEUTRAL] Put that working on this claim on the [PII].
[AGENT][NEGATIVE] No, sir, that's incorrect.
[CUSTOMER][NEUTRAL] Spoken with [PII]. I stated primary you will be received on [PII]. He stated primary EOB was received.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] OK. Who did he speak with?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, we do not have a [PII] here at APL.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] So I need to send the claim to the same mailing address which you had given me before?
[AGENT][NEUTRAL] That is correct. And again, this claim states benefits are payable only if your major medical insurance provider provides benefits. If this claim is later paid by your major medical insurance, please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] What is the effective date and the termination date?
[AGENT][NEUTRAL] Effective date is [PII] and no term date.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, sir, and is there anything else that I can help you with, [PII]?
[CUSTOMER][POSITIVE] No, that's it. Thank you so much for your time bye bye.
[AGENT][POSITIVE] OK. You're very welcome and thank you for calling APL. I hope you have a nice day.
[CUSTOMER][POSITIVE] You too. You can hang up.
[AGENT][POSITIVE] Thank you.