AccountId: 011433970860
ContactId: 5fd6dd8e-aa9e-430c-9a37-54f72884030c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1160819 ms
Total Talk Time (AGENT): 321228 ms
Total Talk Time (CUSTOMER): 424527 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/5fd6dd8e-aa9e-430c-9a37-54f72884030c_20250107T16:39_UTC.wav
--------------------------------------------
[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 the provider's office to check on uh claim status.
[AGENT][NEUTRAL] OK, well, I'll be more than happy to help you with the claim status, [PII]. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Total 5 claims.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected and the policy number?
[AGENT][NEUTRAL] For the first member?
[CUSTOMER][NEUTRAL] Sure. The contact, the contact number is [PII]. And the policy number is 01755271.
[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] Sure. It is [PII].
[CUSTOMER][NEUTRAL] Aquijo. Date of birth, [PII]. And you said your name was [PII]?
[AGENT][NEUTRAL] Yes, that's correct. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You're welcome. And [PII], may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The date of service for the claim is, one moment.
[CUSTOMER][NEUTRAL] It is [PII]. And the total bill charge is $9340 even.
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[AGENT][NEUTRAL] And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. And [PII], can you verify the name of the provider's office that would be on this claim?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The providers, I mean, the facility's name is HCA Florida Mercy Hospital.
[AGENT][NEUTRAL] Thank you. So I'm showing that the claim was received on [PII].
[AGENT][NEUTRAL] And that claim number is 349.
[AGENT][NEUTRAL] 9375.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK. Let me check if any UP was sent from our side.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, recently, the UB was sent on [PII]. Can you please kindly check whether the UB was received on your end?
[AGENT][NEGATIVE] So we have not received the explanation of benefits. We haven't received anything for this member since um [PII].
[CUSTOMER][NEUTRAL] OK. Then,
[CUSTOMER][NEUTRAL] Can you please provide me your
[CUSTOMER][NEUTRAL] Fax number so that I can fax it over to you.
[AGENT][NEUTRAL] Of course, so it's um [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. May I get the time silent limit?
[AGENT][NEUTRAL] There's no timely filing as long as the policy was active on the data service and this policy has been active since um [PII].
[CUSTOMER][NEUTRAL] OK. And you need only the primary UB along with the claim form, both the things together?
[AGENT][NEUTRAL] Um, that's up to you. You can send just the explanation of benefits or you can attach it to the claim form.
[CUSTOMER][NEUTRAL] OK. We'll send the explanation of benefits to you. And may I get the call reference number for the entire call?
[AGENT][NEUTRAL] Yes, that will be my name in today's date. Um, I already gave you the first initial, right? [PII], just to make sure.
[CUSTOMER][POSITIVE] OK. Thank you so much. Let me go ahead and get the next one here.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] I'm ready for the next policy number?
[AGENT][POSITIVE] Yes, I'm ready.
[CUSTOMER][NEUTRAL] OK. It is 1411867 M like Mike, L like Larry, number 7.
[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, sure. Just one moment.
[CUSTOMER][NEUTRAL] Member's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Yes, I'm looking for that information here.
[CUSTOMER][NEUTRAL] The date of service for the claim is [PII]. And the amount is $7,323.63.
[AGENT][NEUTRAL] Thank you. Hold on one moment. Would this be a different provider or the same provider for all the claims?
[CUSTOMER][NEUTRAL] Uh, it is for this one, it is HCA Florida, Woodmont Hospital.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] So I'm showing that the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 7854.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So for this one, we have sent the explanation of benefits on [PII].
[CUSTOMER][NEUTRAL] Did you receive it on your end?
[AGENT][NEGATIVE] No, we have not received it. Um, we haven't received anything for this member since [PII].
[CUSTOMER][NEUTRAL] OK. So for this one also, we need to send the explanation of benefits to the fax number [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. And for all the claims which denied for the explanation of benefits, there is no primary, you'll be attached with the claim form also rate just for the confirmation?
[AGENT][NEUTRAL] There, right, there is no explanation of benefits received, yes.
[CUSTOMER][NEUTRAL] OK. Just for the confirmation so that we can be able to send the explanation benefits to you.
[CUSTOMER][NEUTRAL] Let me get the next one here.
[CUSTOMER][NEUTRAL] OK. Are you ready for the next one?
[AGENT][POSITIVE] Yes, I'm ready.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next policy number is 01896422.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The member's name is [PII]. Date of birth, [PII], sorry, [PII].
[AGENT][POSITIVE] Thank you for that and the data service and total bills.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. The date of service is [PII]. And the total charge is $3,923 even. And for this one, the facility name is gonna be Round Rock Hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Here we go. Alright, so I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] The claim number is 353.
[AGENT][NEUTRAL] 393 1.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary.
[CUSTOMER][NEUTRAL] OK. Just one moment. Let me check if the Prime UP is on file.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And for this one also, we have sent the UB on [PII]. Have you received the UB in your end?
[AGENT][NEGATIVE] No, we haven't. We haven't received anything since [PII] for this member.
[CUSTOMER][NEUTRAL] OK, then we need to send it to the same fax number, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK. Thank you so much. So let me go ahead and get the next one here. Just two more claims.
[CUSTOMER][POSITIVE] Just one moment. I'm getting that information pulled up here. Thank you so much. The next policy number is 01677458 M like Mike.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and the date of service and total bills?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The date of services
[CUSTOMER][NEUTRAL] [PII]. And the total charge is
[CUSTOMER][NEUTRAL] $10,825 even.
[AGENT][NEUTRAL] Thank you. And again, all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And would this be a different provider?
[CUSTOMER][NEUTRAL] Uh, just one moment. For this one, the name of the provider is Memorial University Medical Center or Memorial Savannah.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] That claim number is 352.
[AGENT][NEUTRAL] 0162.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting an explanation of benefits from primary.
[CUSTOMER][NEUTRAL] OK. For this one, we have then that you'll be on [PII]. Can you please check whether the bill is received on your end?
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Let me see if this is it.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, so we haven't, I mean, we received other claims for that day, but there's still not that total bill, so we haven't received that explanation of benefits, um, for your claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, then we will uh resend the explanation of benefits to fax and we'll fax it over to you. And thank you so much for this information.
[AGENT][POSITIVE] You're very welcome. Was there an, oh.
[CUSTOMER][NEUTRAL] Let me go ahead and get.
[CUSTOMER][NEUTRAL] Yes, just the last one. Just one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. The last policy number is going to be 02549585 M like Mary, L like Larry, the number is 7.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. The member's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] So the date of service is gonna be.
[CUSTOMER][NEUTRAL] One moment
[CUSTOMER][NEUTRAL] [PII]. And the total charge is $49,647 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I'm not showing a claim on file for that data service.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] I do have here the claim number. Can you please verify me, uh, verify with the claim number, what I have here?
[AGENT][NEUTRAL] Sure, what's the claim number?
[CUSTOMER][NEUTRAL] 353-261-1
[AGENT][NEUTRAL] OK, that's a different policy number. Hold on one second, let me go to that policy. So that's processed on policy number 2069892 and let me get that claim. Hold on one moment.
[AGENT][NEUTRAL] 2611. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold? this is confusing between the two, but hold on one moment, OK?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What now?
[AGENT][NEUTRAL] 353261-1, it's under Louis. Louis is part what? OK, wait.
[AGENT][NEUTRAL] 2069.
[AGENT][NEUTRAL] 98.
[AGENT][NEUTRAL] 2.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes, hello.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So, um, yes, that claim was processed under a different claim or policy number 2069982. We received it on [PII], um, the claim number you have, and also on [PII], the claim was denied requesting the explanation of benefits from primary.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, just one moment. Let me update this policy number here.
[CUSTOMER][NEUTRAL] OK. So, the UHC is primary. And for this one also, we have sent the UB explanation of benefits on [PII]. Can you please check whether it was received on your end?
[AGENT][NEGATIVE] Yes, this has not yet been received.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So let me go ahead and send the explanation of benefits for all the claims to the fax number [PII]. So, did I get the correct fax number here?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK. Thank you so much for all the information and thank you so much for your time and assistance. Have a good day. Take care. Bye for now.
[AGENT][POSITIVE] You also, thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.