AccountId: 011433970860
ContactId: 6d5e54b3-64ed-4e70-81ed-ae0b89fedb44
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1551900 ms
Total Talk Time (AGENT): 418607 ms
Total Talk Time (CUSTOMER): 424878 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/6d5e54b3-64ed-4e70-81ed-ae0b89fedb44_20250411T15:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling to check on a claim.
[AGENT][NEUTRAL] OK, Miss, and you said [PII] is your name?
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][POSITIVE] Thank you so much, Ms. [PII], and I can help you with claim status. Can I please get your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] It's [PII]. And it's a direct line.
[AGENT][NEUTRAL] Thank you very much, Ms. [PII]. And what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII] [PII]. And for the policy ID it's 018.
[CUSTOMER][NEUTRAL] 358
[CUSTOMER][NEUTRAL] 96
[CUSTOMER][NEUTRAL] M [PII] Lima, 8.
[AGENT][NEUTRAL] OK, let me look that policy up for us real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, I've got Ms. [PII] pulled up. What is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] [PII], 20244127741.
[AGENT][NEUTRAL] And that's $1,277.41. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and then what's the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] It's $500 even.
[AGENT][NEUTRAL] Thank you and may I please get the name of the facility you're calling from?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] HCA.
[CUSTOMER][NEUTRAL] Florida University Hospital.
[AGENT][NEUTRAL] OK, Miss [PII], I'm gonna put you on a brief hold while I look this claim up for us and I'll be right back, ma'am.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you very much, Ms. [PII], for holding for me. I have the claim ready for you.
[AGENT][NEUTRAL] Are you there, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes, I was on mute. Sorry. Go ahead, please.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, the claim number is 3465526 and the claim was denied because the
[AGENT][NEUTRAL] We need the explanation of benefits from the primary insurance carrier.
[AGENT][NEUTRAL] And I also have a different policy number that the claim is filed under.
[CUSTOMER][NEUTRAL] All right. And could you also make sure we uh received two correspondence, the one under the claim number which you provided, denying for primary EOB and the other claim number which is getting denied for duplicate claim. Uh, could you please check if there is uh a other EOB which is denying for duplicate?
[AGENT][NEUTRAL] Yes, I can check that for you. I'm gonna put you on a brief hold while I look that up. I'll be right back, Miss [PII].
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 356-856-5
[AGENT][NEUTRAL] Thank you very much for holding for me, [PII]. So on um claim 356-8565, which is the duplicate claim, um, we still need the EOB from the primary insurance. The only information I have from this one is that it's duplicated.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. Thank you so much for this information. And for my documentation purpose, could you please help me when you have received the duplicate claim and when it was denied?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let me look it up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, the claim was received on [PII] and processed on [PII], and we need the primary EOB from the insurance carrier.
[CUSTOMER][NEUTRAL] And for my documentation purpose, uh, could you please check whether the duplicate claim which you have received uh was submitted with the primary insurance explanation of benefits?
[AGENT][NEUTRAL] I can't see that information. I can only verify how the claim was processed.
[CUSTOMER][NEUTRAL] All right, one moment.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Could you please help me with the original claim receipt and process date?
[AGENT][POSITIVE] Yes ma'am, let me get that for you.
[AGENT][NEUTRAL] Uh, the original claim was received on [PII].
[AGENT][NEUTRAL] And was also processed on [PII].
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you so much. And you want us to send the primary insurance explanation of benefits, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And may I know uh it is required to send the claim form attached with the primary UB or just the UB is enough?
[AGENT][NEUTRAL] I would attach the claim form with it.
[CUSTOMER][NEUTRAL] All right, thank you. And can I have the mailing address and the fax number?
[AGENT][NEUTRAL] Yes, the fax number is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] The claim's mailing address is [PII]. That's in [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right, thank you. Thank you so much for this information. And is there any timely filing limit?
[AGENT][NEUTRAL] No, there's not.
[CUSTOMER][NEUTRAL] All right, thank you. And uh may I know how many claims can you assist over the call? I do have 2 more.
[AGENT][POSITIVE] I can help you with those.
[CUSTOMER][NEUTRAL] All right. Just give me allow me one quick moment. I'll move to the next number information.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Yes ma'am, go ahead and take your time.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] For this account, you s[PII] like the member's ID is different. Could you please help me with that for my documentation?
[AGENT][NEUTRAL] Yes, the, um, the good policy number is 2,013,290.
[CUSTOMER][POSITIVE] All right, thank you so much for the additional information. And one moment, I'll move to the next claim.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And when you're ready, I'll just need, uh-huh, yes.
[CUSTOMER][NEUTRAL] And may I know whether I can go ahead with the, uh-huh, yes, go ahead.
[AGENT][NEUTRAL] Um, with the next claim, I'll just need the member's name, uh, uh, date of birth, and policy number.
[CUSTOMER][NEUTRAL] All right. Uh, the first name is [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK, and the policy number, please?
[CUSTOMER][NEUTRAL] 02446039 M as in Mike L as in Lima 7.
[AGENT][NEUTRAL] OK, let me pull that policy up for us real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I do have on it pulled up. Um, can you please give me the data service and the charge amount?
[CUSTOMER][NEUTRAL] The date of service is [PII]. It's a single date range and the amount is $67,0086 even.
[AGENT][NEUTRAL] OK, and then what's the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] It's $500 even.
[AGENT][POSITIVE] Oh, thank you. And the name of the facility for [PII]?
[CUSTOMER][NEUTRAL] HC Florida Kendal Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look this one up and I will be right back with you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you, Miss [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, Ms. [PII]. I have this claim ready for us now. The claim number is 343-839-93.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was also denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Thank you. And could you please help me with the received date and denied date?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] The claim was received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Thank you. And could you please help me with the claim number again?
[AGENT][NEUTRAL] Yes, it's 343-839-93.
[CUSTOMER][POSITIVE] Thank you so much. And could you please check previously we have sent the claim form and the primary insurance explanation of benefits.
[AGENT][NEUTRAL] OK and when did you send that in?
[AGENT][NEUTRAL] On what day?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] That was sent on [PII].
[AGENT][NEGATIVE] I am not showing that we have received anything on that day.
[CUSTOMER][NEUTRAL] All right. And could you please help me with the mailing address and the fax number? Is that the same one?
[AGENT][NEUTRAL] Yes, it's the same.
[CUSTOMER][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] One second, I'll move with the last number information.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I spell the next member's name. It's [PII] [PII] again, [PII] [PII]. Last name [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is Priscilla's policy number?
[CUSTOMER][NEUTRAL] 01866950 M as in Mike L as in Lima 7.
[AGENT][NEUTRAL] OK, let me pull up this one for us real quick.
[CUSTOMER][NEUTRAL] Mhm. Sure.
[AGENT][NEUTRAL] OK, and then what is Priscilla's data service and the charge amount?
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Date of service is [PII]. And the amount billed is $15,239 even.
[AGENT][NEUTRAL] OK, and charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's $500 even.
[AGENT][NEUTRAL] OK, and may I get the name of the facility for this one?
[CUSTOMER][NEUTRAL] Southern Health Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look this one up for us and I will be right back, Miss [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, Ms. [PII]. So looking on data service of [PII], I do not find a claim in the amount that you have given.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right, one quick moment, I'll double check here.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And I could see previously uh there was multiple submissions and the last one was on 10-27-2024.
[CUSTOMER][NEUTRAL] Through paper, and I would like to verify the mailing address. Is that is [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] MS zip code is [PII]. Is this the correct address?
[AGENT][NEUTRAL] No, ma'am, that's incorrect. Let me give you the good address.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] It's the same one, the [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] For my documentation purpose, for all the claim submission and to submit the primary insurance EOB, it will be the same mailing address?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] All right, thank you. And uh may I have the claims timely filing limit?
[AGENT][NEGATIVE] We do not have a timely filing limit.
[CUSTOMER][NEUTRAL] All right. And for this number, could you please help me with the policy effective and term date? And one moment, um,
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, sorry for getting into other question. Uh, for this, uh, there is a fax number to submit the claim and payer ID?
[AGENT][NEUTRAL] Yes, the fax number is the one I gave you earlier, [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the claims payer ID number is 60801.
[AGENT][NEUTRAL] The effective date of this policy is [PII] and the policy is still active and current.
[CUSTOMER][NEUTRAL] And do you have the plan type?
[AGENT][NEUTRAL] Medlik
[CUSTOMER][NEUTRAL] Could you please spell out?
[AGENT][NEUTRAL] M E D L I N K.
[CUSTOMER][NEUTRAL] Thank you. And do you have the group number or group name?
[CUSTOMER][NEUTRAL] you know.
[AGENT][NEUTRAL] Yes, the group number is 24141.
[AGENT][NEGATIVE] And it's the group name is Food for the Poor Incorporated.
[CUSTOMER][NEUTRAL] Could you please repeat the name again?
[AGENT][NEGATIVE] Food for the poor.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Incorporated.
[CUSTOMER][NEUTRAL] Uh, could you please, uh, help me with the first name? Could you please spell out?
[CUSTOMER][NEUTRAL] Before incorporated?
[AGENT][NEGATIVE] [PII]
[AGENT][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Food
[AGENT][NEUTRAL] 4 FOR.
[AGENT][NEUTRAL] The THE.
[AGENT][NEGATIVE] Poor POOR.
[CUSTOMER][POSITIVE] All right. Thank you so much for spelling that out.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And may I know your preferred method, uh,
[CUSTOMER][NEUTRAL] Uh, by the fax or electronic or paper submission, which method do you prefer?
[AGENT][NEUTRAL] It doesn't matter whatever's the easiest for you.
[CUSTOMER][NEUTRAL] All right, thank you. And for the whole call reference, will that be your name in today's date?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] All right. Thank you. Thank you so much for your assistance. Have a great day. Bye-bye.
[AGENT][POSITIVE] You too, [PII]. That's all I can help you with today?
[AGENT][NEUTRAL] Is there any other questions you may have?
[CUSTOMER][NEUTRAL] And one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yes, and, uh, like the second claim which I checked for, even I could see there was an additional correspondence for duplicate and the original one was denying for primary EOB and for my documentation purpose, are you able to help me with the receipt and deny date of the duplicate claim, please?
[AGENT][NEUTRAL] Yes, I gave that to you uh let me look it up again.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] That was for [PII].
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] It was for [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] OK, [PII] did not have a duplicate claim.
[CUSTOMER][NEUTRAL] Um, one moment.
[AGENT][NEUTRAL] I think it's the first one. Let me check.
[CUSTOMER][NEUTRAL] For the number.
[AGENT][NEUTRAL] For [PII], let me.
[CUSTOMER][NEUTRAL] Uh, no, for the first one, I just got the
[CUSTOMER][NEUTRAL] I just got the duplicate claim information. And one moment, I'll double-check with the correspondence for [PII]. One second, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, for [PII], for [PII], last name [PII] For that number, I could see.
[CUSTOMER][NEUTRAL] One moment, to correspondence.
[CUSTOMER][POSITIVE] All right. Uh, I do apologize. I see both the corresponding status for explanation of benefits. All right, thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] And thank you.
[CUSTOMER][POSITIVE] No, thank you. Thank you so much for patiently assisting. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're very welcome. You have a wonderful weekend and thank you for calling APL. Bye-bye, ma'am.
[CUSTOMER][POSITIVE] You too. Thank you. Bye.