AccountId: 011433970860
ContactId: 741ddba1-205e-4a49-a039-14006f0bc09f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 717700 ms
Total Talk Time (AGENT): 229313 ms
Total Talk Time (CUSTOMER): 391819 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/741ddba1-205e-4a49-a039-14006f0bc09f_20250116T21:31_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], and I'm calling in reference to, uh, a few pending claims that I submitted that I would like to provide the information that is missing. So what should I give you before we proceed?
[AGENT][NEUTRAL] OK, let me, um, first of all, I'll need to get your name. Can you please give me your name and spell it for me?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it's [PII], and the first name is spelled [PII], I'm sorry, [PII]. Last name [PII]
[AGENT][POSITIVE] OK. Thank you so much for spelling me that your name, and I said [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] German, uh-huh.
[AGENT][NEUTRAL] Alright, Ms. [PII], what is your callback number just in case our call gets disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you and then what is the patient's name?
[CUSTOMER][NEUTRAL] It's um, honestly, uh, I, well, I still have a few.
[CUSTOMER][NEUTRAL] So I don't know for which I, I can tell you the ones that, the claim number. Maybe that will help, cause I know they're incomplete because I need to provide more information. Like as an example, have 324-4900, and that's for [PII], my, my husband.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this is your policy, is that correct? You're not with the facility, so this is your own policies. OK, what is your policy number?
[CUSTOMER][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Policy, it's 02140827.
[CUSTOMER][NEUTRAL] M. like Mike. L. like Lima 7.
[AGENT][NEUTRAL] OK, let me pull that up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you so much. And for security reasons, can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. And then what is your address, phone number, and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] My home address is [PII]. My phone number is [PII]. My email is the same as my [PII] [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK, thank you. I appreciate you verifying the information for me.
[AGENT][NEUTRAL] OK, so you did send in claim let me look and see real quick, check something.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and you said it was for your spouse. Is that, is that correct?
[CUSTOMER][NEUTRAL] Yes, um, one of them are actually for my, my husband, cause it's really a hassle to get the documents from my doctor. Um, I was just speaking to one of your associates a minute ago, but, um, then I went to the clinics and I said, but I don't know which doctor is this and.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So, uh, you know, I, so I was gonna ask you for that. I have access to to my EOBs from [PII].
[CUSTOMER][NEUTRAL] However, when I call my insurance, they say you can grab the EOB from the website, but the website doesn't have the diagnosis code. So one of your co-workers explained to me and said you need to tell your doctor's office for the form name C Charlie Mike S like Sierra 1500.
[CUSTOMER][NEGATIVE] So because I've been calling my doctor and they send me to third parties like whoever does the billing for them, like other company in another state, so when I call them, they don't know who am I, they don't deal with private, you know, people, only with doctors, so it's like I'm in the middle. I don't get those information, so, so I was told to specifically ask them for the CMS 1500.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So hopefully this time I got uh unlucky and I get that information to finish processing the ones that I have for 223 because I have a few from [PII] that I have not started yet because I still have this pending.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Did you get the CMS 1500 form?
[CUSTOMER][NEUTRAL] Not yet, because I'm, I'm, I was gonna ask you like as an example, if we take the one for
[CUSTOMER][NEUTRAL] [PII] that says claim number 3,244,900. If you can tell me who's the doctor so I can ask them for the form.
[AGENT][NEUTRAL] OK. All right. Let me look.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm looking at the, the claim and there's two doctors, [PII].
[CUSTOMER][NEUTRAL] OK. Do you know what is the speciality?
[AGENT][NEUTRAL] Do I know, I'm sorry, do I know what?
[CUSTOMER][NEUTRAL] Yeah, what is this, the specialty, if it's a dermatology, if it's a, you know, what kind of doctor is he? It doesn't show.
[AGENT][NEUTRAL] It doesn't
[AGENT][NEUTRAL] It does not say it just says [PII].
[AGENT][NEUTRAL] MD
[CUSTOMER][NEUTRAL] Do you have the date of service?
[AGENT][NEUTRAL] The date of service was [PII].
[CUSTOMER][NEUTRAL] OK, [PII]. OK. So it only has [PII] mhm.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Yes, and then there's another doctor.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like it's [PII], it's spelled [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, I think that's the dermatology. Yes, I think, yes.
[AGENT][NEUTRAL] That date of service was [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah, that's the dermatology. OK.
[CUSTOMER][NEUTRAL] OK, and then if I go now to the one or another one pending that I have is [PII].
[AGENT][NEUTRAL] [PII]. OK, let me look that one up for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, this one is for.
[AGENT][NEUTRAL] And Telerad imaging.
[CUSTOMER][NEUTRAL] Um, I imagine.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On data service [PII].
[CUSTOMER][NEUTRAL] OK, [PII] and it does have doctor's name?
[AGENT][NEGATIVE] No, it does not.
[CUSTOMER][NEUTRAL] And you say the first word was before imagine what?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] OK. I see. OK.
[CUSTOMER][NEUTRAL] And then the other one that I have pending is [PII].
[AGENT][NEUTRAL] Let me look at that one.
[AGENT][NEUTRAL] OK, that's um HCA Florida Kendall Hospital.
[CUSTOMER][NEUTRAL] OK, and that was it. OK, that's urgent care. OK, and that was the date of service?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] The next one that I have and last one is [PII].
[AGENT][NEUTRAL] OK, let me pull that one in.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] South Miami Hospital.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the date of services?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you need also, you know, the CMS because all of them are missing the same form, because that's the hardest, hardest one to get.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Yes, and another thing that you can do there's another thing that you can do and you can just ask them I mean they can say yes or they can say no but you can call them and tell them that you have outstanding claims with with their facility, let me give you the payer ID number you give them the payer ID number and see if they will file it electronically for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. The payer ID number is 60.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] OK. 60 801.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and that's you, right? That's your payer ID.
[AGENT][NEUTRAL] Yeah, that's payer ID for.
[CUSTOMER][NEUTRAL] So they can send it to you. Mhm. Mm.
[AGENT][NEUTRAL] So they can send it to us electronically.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] In case if they wanna give it to me, because that's what I perceived, that they just don't wanna give it to me.
[CUSTOMER][NEUTRAL] They just wanna get, because they have codes, I guess those are internally only for them to use, and I guess with other insurance, it's like a language, I guess just for them, and they don't wanna I guess, um, you know, release it to the public. I guess that's what it is.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, right.
[AGENT][NEUTRAL] Well, I'd call them and ask them, look, I've got a payer ID number. If I give this to you, can you please file the claims for me?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Great, you just give me a great idea. Perfect. Uh-huh.
[AGENT][NEUTRAL] And they may you know but unless you ask, the answer's no unless you ask, right?
[CUSTOMER][NEUTRAL] Yeah, cause that is right, yeah, that is correct, yes. OK, and that is something, [PII], that is done, um, you know, that document, let's say that I go to the doctor today, right? And when I walked out and I'm checking out, is that form automatically generated in the system or that is something that they have to process through the days?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, they will have to process it because they have to um.
[AGENT][NEUTRAL] File with your primary insurance first.
[CUSTOMER][NEUTRAL] Oh, OK, I see, perfect. OK, OK, well, you just gave me a lot of information today that I'm gonna help me now to resolve this before I submit the new ones for last year.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Thank you.
[AGENT][POSITIVE] You're so welcome. You're welcome, Ms. [PII]. Thank you so much for calling APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you very much.
[CUSTOMER][POSITIVE] Thank you. Thank you again. Bye. bye.
[AGENT][NEUTRAL] Bye bye.