AccountId: 011433970860
ContactId: 70915246-aa6e-4531-85f7-faf31b3ef6d0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1018289 ms
Total Talk Time (AGENT): 262113 ms
Total Talk Time (CUSTOMER): 265866 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/70915246-aa6e-4531-85f7-faf31b3ef6d0_20250306T14:46_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, uh, it's [PII] calling from the provider office to know the claim status.
[AGENT][NEUTRAL] OK, well I can definitely help you with the claim status, [PII], and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] It's 01780690 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. The last name is [PII] and 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 for the claim and the total bills?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Date of service is [PII] and the total charge amount is $16,719 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, sure. It's HCA Florida Mercy Hospital.
[AGENT][NEUTRAL] Thank you for that. I'm trying to received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 3513902.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting an explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] As per checking in our system, we have already sent you the primary.
[AGENT][NEGATIVE] Yes, and it was denied as a duplicate.
[AGENT][NEGATIVE] So the explanation of benefits has not been received.
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] You didn't receive it yet. OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Can you just cross-check the fax number is [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] We will send you once again.
[AGENT][POSITIVE] Alrighty, and was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Yes, I have 3 more claims. Can you just help me with it?
[AGENT][NEUTRAL] OK, and they're for the same member?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, no. Different member.
[AGENT][NEUTRAL] OK, hold on one moment, let me note this policy.
[CUSTOMER][NEUTRAL] Yes, can you just tell me the call reference number for this call?
[AGENT][NEUTRAL] The call reference number for the entire call will be my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Yes, it's
[CUSTOMER][NEUTRAL] 02487974 M as in Mike L as in Lima 7.
[AGENT][NEUTRAL] Can you repeat the policy number for me, please?
[CUSTOMER][NEUTRAL] Yeah, sure. It's 02487974 M as in Mike, L as in Lima 7.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] The last name is [PII] and the first name is [PII], and date of birth, [PII].
[AGENT][NEUTRAL] Thank you for that. And again, 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?
[CUSTOMER][NEUTRAL] Yes. It's [PII] and total charge amount is $4,518 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 3551583.
[AGENT][NEUTRAL] And on [PII], the claim was denied, requesting an explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just checking in our system, we have already sent you the primary EOB.
[AGENT][NEUTRAL] OK, and when was the explanation of benefits sent?
[CUSTOMER][NEUTRAL] Just wait a second.
[CUSTOMER][NEUTRAL] We have sent on
[CUSTOMER][NEUTRAL] [PII], [PII], [PII], [PII], and [PII].
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] 115.
[AGENT][NEUTRAL] OK, we haven't received, how did you send it? We received something on [PII], but that's a different um claim.
[AGENT][NEUTRAL] A different data service and total bill.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We have seen with the fax number only.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah, we've only received this one claim, um, there, we haven't received the additional documents.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You can you can mail it or you can send it electronically if you like.
[CUSTOMER][NEUTRAL] OK. Can you just tell me the mailing address?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. And the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][POSITIVE] Yeah, just wait a second, I'll provide you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Anybody have
[CUSTOMER][NEUTRAL] Bye you.
[CUSTOMER][NEUTRAL] you know.
[CUSTOMER][NEUTRAL] Hey, are you ready?
[AGENT][POSITIVE] Yes, I'm ready.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] The policy number is 02518881.
[AGENT][POSITIVE] 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] The last name is [PII], and the first name is [PII]. Date of birth, [PII].
[AGENT][POSITIVE] Thank you for that. And may I have
[AGENT][NEUTRAL] The data service and the total bills?
[CUSTOMER][NEUTRAL] Yes, so the date of service is [PII] and total charge amount is $360,552.92.
[AGENT][NEUTRAL] I'm sorry, can you repeat the dollar amount?
[CUSTOMER][NEUTRAL] It's 360552.92.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And you said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] So we received the claim on the 2nd time on [PII]. Claim number 3571023.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I like
[AGENT][NEUTRAL] And on [PII], the claim was paid a total of $1,625.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you just tell me the pay details?
[AGENT][NEUTRAL] OK, so it was a single check?
[AGENT][NEUTRAL] In the amount of $1,625 it was issued on [PII].
[AGENT][NEUTRAL] The HCA Florida Mercy Hospital.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK. Can I have the EFT number?
[AGENT][NEUTRAL] The check number is 203-088-5.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. Just wait a second.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[CUSTOMER][NEUTRAL] Let me provide you the last account.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And I'm ready when you are.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. Hold on one moment. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes. The last name is [PII] and the first name is [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Thank you. May I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Yes. Date of service is [PII] and total charge $6,944.65.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 3542358.
[AGENT][NEUTRAL] And on [PII], the claim was denied, requesting an explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] As per checking in our system, we have already sent you the primary EOB multiple times.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, so we have not yet received the explanation of benefits. Um, let me see if this claim here, when did this come in?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, um, there, there are two other claims here, but it's a different total bill. As for your total bill, we have not received the explanation of benefits. You can mail it or send it electronically if you like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Can you tell me the payer ID also?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You're very welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Thank you so much for your help.
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] that's.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Yeah