AccountId: 011433970860
ContactId: 7493a79f-aaef-422d-9c48-d5ec3c43409b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1302349 ms
Total Talk Time (AGENT): 314737 ms
Total Talk Time (CUSTOMER): 537968 ms
Interruptions: 15
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/7493a79f-aaef-422d-9c48-d5ec3c43409b_20250305T20:43_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office, and I'm looking for a claim number for the date of injury to submit the medical bills.
[AGENT][NEUTRAL] I'm sorry, you're looking for, can you repeat that slowly, please?
[CUSTOMER][NEUTRAL] $200 payment.
[CUSTOMER][NEUTRAL] I'm looking for the member eligibility to submit the medical claims for the injury portion.
[AGENT][NEUTRAL] OK, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] And the
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][POSITIVE] Thank you for that, and I'll be more than happy to help you with the eligibility. May I have the um policy number?
[CUSTOMER][NEUTRAL] Uh, the policy number I have is 02263078 M [PII] Bravo.
[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] So
[CUSTOMER][NEUTRAL] [PII], date of birth of [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I'm actually showing that this particular policy is no longer active. It was effective from [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So [PII].
[AGENT][NEUTRAL] There is an active policy though, um, which is policy number 254.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 9550.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And that policy has been effective since [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Effective from?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] To still active.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] And the policy ID 2,549,550.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And uh can I have the, uh this is the primary insurance, right?
[AGENT][NEUTRAL] No, this is their secondary insurance.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] OK. For injury portions, this is the insurance we need to submit the claims, right?
[CUSTOMER][NEUTRAL] For the service related to an accident.
[AGENT][NEUTRAL] So, hold on one moment. Let me pull up.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so it's not an accident policy, but this is their secondary um medical policy. So we pay towards the copay, deductible and co-insurance after their primary, and the primary for this um policy is Florida Blue.
[CUSTOMER][NEUTRAL] Showing this is.
[CUSTOMER][NEUTRAL] The next second later
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] That and the primary.
[CUSTOMER][NEUTRAL] BC [PII].
[CUSTOMER][NEUTRAL] OK. Uh, I have a question. The service related to an accident and you found the member.
[CUSTOMER][NEUTRAL] I'm not sure why general commercials is not an auto accident insurance.
[AGENT][NEUTRAL] What's your question? I'm sorry. Can you repeat the question?
[CUSTOMER][NEGATIVE] And they won't cover it.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, this is not an auto insurance like injury claims can be submitted.
[AGENT][NEUTRAL] No, this is not auto insurance. This is secondary medical insurance.
[CUSTOMER][NEUTRAL] secondary.
[CUSTOMER][NEUTRAL] Secondary medical insurance won't cover the injury claims.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, uh, it depends on what you're trying to file.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] If this is for like hospital or like, you know, something medical that you're filing with Florida Blue, you may be able to file with us also. I'm not, it depends on what's being filed.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII], if the service related to an injury, BCBS Florida won't cover the service because accident claims will have a separate coverage and the service related to an accident.
[AGENT][NEUTRAL] And their primary is not applying?
[CUSTOMER][NEUTRAL] And I would like to know.
[CUSTOMER][NEUTRAL] The primary will not going to pay because there's only covering for medical benefits, not accidental claims.
[AGENT][NEUTRAL] OK, so if the primary does not apply, then we a second cannot apply. We can only apply after primary.
[CUSTOMER][NEUTRAL] OK, so the primary does not to me.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. And uh can you help me with the policy ID for the BCBS?
[AGENT][NEUTRAL] Um, we don't have the policy information for Florida Blue. We just have the name of the the insurance company.
[CUSTOMER][NEUTRAL] You have the
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And uh can you help me with the mailing address to submit the claim?
[AGENT][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Payer ID
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801 Family filing Limited.
[AGENT][NEUTRAL] There's no timely filing limit?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And I have a few more members. Can I proceed to the next member?
[CUSTOMER][NEUTRAL] For eligibility.
[AGENT][NEUTRAL] OK, hold on one moment. Um, let me note this policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 160120137.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] 1734.
[AGENT][NEUTRAL] 160120137.
[CUSTOMER][NEUTRAL] here.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No, can you try the name and date of birth instead?
[AGENT][NEUTRAL] Um, that's too many numbers. Do you have the member's ID card available?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thank you. The member name I have is, uh, the first name spelled.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] [PII] the [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Date of birth. Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] OK, so I'm just waiting for the policy to come up here. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so I believe I located the policy. I'm looking to see if it's him. And what is the date of birth?
[CUSTOMER][NEUTRAL] Date of birth of the member is [PII].
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] OK, so we only have one policy here with the name of [PII], but the date of birth is different.
[CUSTOMER][NEUTRAL] OK, so we only have one policy you have the name of that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Do you have a social for the member?
[CUSTOMER][NEUTRAL] No, I have the home address. Uh, the patient has an additional name of [PII] in the first name, [PII].
[AGENT][NEUTRAL] Can you spell that, um, the first name?
[AGENT][NEUTRAL] The chalice.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. [PII]. OK, hold on one moment.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Member ID number is [PII] like [PII].
[AGENT][NEUTRAL] OK, so there's no policies with [PII], so I'm looking for [PII], um, but it doesn't look like there's a policy here. Do you have a cop, you said you don't have a copy of the ID card?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, so for that one, we're going to need more information to be able to search.
[CUSTOMER][NEUTRAL] OK, so for that one we're gonna need.
[CUSTOMER][NEUTRAL] OK, there is no member with the details.
[CUSTOMER][NEUTRAL] OK, we can proceed to the next member.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If you don't mind.
[CUSTOMER][NEUTRAL] Let me close this.
[CUSTOMER][NEUTRAL] Next member.
[CUSTOMER][NEUTRAL] ID number.
[CUSTOMER][NEUTRAL] Whenever you're ready.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] 3450085285
[AGENT][NEUTRAL] This is their policy number?
[CUSTOMER][NEUTRAL] Not sure. I think it's like a Medicaid ID.
[AGENT][NEUTRAL] So if this is anything from Medicaid or Medicare, APL is not affiliated.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, OK. Uh, can you try the name and date of birth instead? Thank you. The member's first name spells as [PII].
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Last name, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] you need the number?
[CUSTOMER][POSITIVE] Got it. Uh thank you so much. Have a great day.
[AGENT][NEUTRAL] OK, so there's no one with the name [PII], um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There is a [PII]
[AGENT][NEUTRAL] Right. What's the date of birth?
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, now.
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] OK. Right. No.
[CUSTOMER][NEUTRAL] Let me proceed to the next one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just have 2 more accounts to check.
[CUSTOMER][NEUTRAL] The next member ID.
[CUSTOMER][NEUTRAL] He's uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What's the member's first and last name?
[CUSTOMER][NEUTRAL] [PII], sorry, M.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. Date of birth of uh [PII].
[AGENT][NEUTRAL] The first name is [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Last name [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what's the date of birth?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Reado
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so I did find a policy for [PII].
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] And the policy number is 9, I'm sorry, 983409.
[CUSTOMER][NEUTRAL] Uh, to the [PII].
[AGENT][NEUTRAL] However, the policy is no longer active. It was effective from [PII].
[CUSTOMER][NEUTRAL] 1.
[CUSTOMER][NEUTRAL] [PII] is the termination date, but I have a date of service, [PII], so the member is active during the date of service I'm looking for.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] So what was the date of service?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] [PII]. [PII].
[AGENT][NEUTRAL] Right, [PII].
[AGENT][NEUTRAL] Right, [PII], the policy terms in [PII].
[CUSTOMER][NEUTRAL] Oh, I thought it was [PII].
[CUSTOMER][NEUTRAL] But you said the effective date of [PII].
[AGENT][NEUTRAL] The policy was effective from [PII].
[AGENT][NEUTRAL] To [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] No active coverage then.
[CUSTOMER][NEUTRAL] So it's not enrolled again after the termination.
[AGENT][NEUTRAL] Right, there was no active coverage on the data service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Let me proceed to the last one.
[CUSTOMER][NEUTRAL] what
[AGENT][NEUTRAL] OK, and I'm ready when you are for the next policy number?
[CUSTOMER][NEUTRAL] It's 4, I'll start out with 427-441-159.
[CUSTOMER][NEUTRAL] 143.
[AGENT][NEUTRAL] And what's the member's first and last name?
[CUSTOMER][NEUTRAL] Member's name is uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Covenant.
[CUSTOMER][NEUTRAL] Si
[CUSTOMER][NEUTRAL] Last name is [PII]. Date of birth of [PII].
[AGENT][NEUTRAL] Thank you. And can you spell the first and last name for me, please?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Last name, [PII].
[AGENT][NEUTRAL] OK, thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm just waiting for the policies to populate. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So I tried it with, so Covenant Gre you said there's a hyphen in between?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I'm not showing a policy with that name. Do you have the member's social?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, if you're not able to find them.
[AGENT][NEUTRAL] Is this, this may be this, is this their social security number?
[AGENT][NEUTRAL] The [PII]
[CUSTOMER][NEUTRAL] Uh, might be, yeah, this is a [PII]. You can try it.
[AGENT][NEUTRAL] You want me to try it, OK.
[AGENT][NEGATIVE] No, that didn't pull up anything. I thought it was the social.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can I have a reference number for a conversation?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. Again, that's [PII] my [PII].
[CUSTOMER][POSITIVE] Thank you, [PII]. It's nice talking to you. Bye for now.
[AGENT][POSITIVE] It was nice speaking with you as well. Thanks for calling APL. Bye-bye.