AccountId: 011433970860
ContactId: 6db3f5d7-218a-4381-bc5a-7186aecd7af2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 401279 ms
Total Talk Time (AGENT): 118026 ms
Total Talk Time (CUSTOMER): 133798 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/6db3f5d7-218a-4381-bc5a-7186aecd7af2_20250522T13:41_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, I'm [PII] here I see last name initially it's calling from the provider's office to check up on the claim status.
[AGENT][POSITIVE] 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] One
[AGENT][NEUTRAL] Alright, and may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] [PII] and it's a direct line. And the patient's policy number is 0243.
[CUSTOMER][NEUTRAL] 3300.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] and
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII], last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Date of service is [PII] for the bill amount of $13,193.25.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm sure we, well, first, can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] I see Florida Lake City Hospital.
[AGENT][NEUTRAL] Thank you. I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Claim number is 358.
[AGENT][NEUTRAL] 5406.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the insured's primary insurance provided full benefits, there are no benefits available or payable, sorry.
[CUSTOMER][NEUTRAL] Like the maximum benefits, right?
[AGENT][POSITIVE] Yes, the primary insurance paid the full benefits.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Yes, I can hear you. Like I was just asking like, uh, in the terms of dollar value or by number of visits.
[CUSTOMER][NEUTRAL] you know, but you know.
[AGENT][POSITIVE] Dollar value, they provided full benefits, so they paid the claim.
[CUSTOMER][NEUTRAL] Well, like the uh maximum benefits met in this claim or in the previous one?
[AGENT][NEUTRAL] We're only working with one claim.
[AGENT][NEGATIVE] This and what we're saying is from the explanation of benefits that we received, it showed that their primary insurance paid for everything, so there's nothing for us to pay.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] If you have an explanation of benefits showing that, go ahead.
[CUSTOMER][NEUTRAL] OK, like
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, like in the previous, like in the primary insurance has paid all the benefits and there is no benefits left to be left to get any amount.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK. So like in this claim, there is nothing left and in the previous one, it was already exhausted.
[AGENT][NEUTRAL] When you say previous, what are you referring to? Is there another claim that you want me to look at previous what?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Like previous insurance, primary one.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] I don't understand um what you mean, but all this is saying is their primary insurance paid for everything.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK. And just give me one minute, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK so.
[CUSTOMER][NEUTRAL] you're gonna
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] yeah all the way up to 2.
[CUSTOMER][NEUTRAL] And what is the amount that is, that will not, what is the allowed amount?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] For the secondary policy?
[CUSTOMER][NEUTRAL] Yes, for the secondary secondary insurance.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] 15
[CUSTOMER][NEUTRAL] which one?
[AGENT][NEUTRAL] Outpatient, the benefit is up to $3000 per calendar day.
[CUSTOMER][NEUTRAL] Yeah that's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is the allowed amount?
[AGENT][NEUTRAL] $3000 per day.
[CUSTOMER][NEUTRAL] And what is the patient responsibility?
[AGENT][NEUTRAL] OK, so for one, we don't determine patient responsibility because we're not the major medical, but there's also no patient responsibility because primary has paid everything.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And what will be the call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you for your assistance. Bye.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah.