AccountId: 011433970860
ContactId: 770d5291-df93-43fa-9b82-7bc0c8bf9fff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 371859 ms
Total Talk Time (AGENT): 136864 ms
Total Talk Time (CUSTOMER): 130862 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/770d5291-df93-43fa-9b82-7bc0c8bf9fff_20250407T12:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, ma'am. My name is [PII]. I'm calling from American Anesthesiology of Florida.
[CUSTOMER][NEUTRAL] And I was calling to verify um active coverage for a member.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] My direct line is [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] It's 02169009 M as in Mary, L as in Larry, the number 7.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active. And is this for inpatient or outpatient benefits or services provided in the office?
[CUSTOMER][NEUTRAL] It looks like it's um it's outpatient, I'm sorry, inpatient services, um.
[CUSTOMER][NEUTRAL] And I don't believe that we've submitted the claim to you as of yet, but the date of service is [PII].
[AGENT][NEUTRAL] OK. And for inpatient services, we cover up to 3500 per calendar year and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim. And you said the date of service [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What are the bill charges?
[CUSTOMER][NEUTRAL] $2,518.20. The primary insurance, I believe just recently processed, so I don't believe we've submitted to um the secondary yet.
[AGENT][NEUTRAL] Yeah, there is one claim on file for anesthesia. Let's see, for that date of service.
[CUSTOMER][NEUTRAL] Oh, you do have one, OK.
[AGENT][NEUTRAL] And please repeat the bill charges.
[CUSTOMER][NEUTRAL] Um, it's $2,518.20.
[AGENT][NEUTRAL] And who's the provider, the name of the provider?
[CUSTOMER][NEUTRAL] For this one, well, I have 2,
[CUSTOMER][NEUTRAL] So the one I'm referring to is Doctor [PII] is the last name, [PII]
[AGENT][NEUTRAL] For American Anesthesiology of Florida.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, yeah, that claim.
[CUSTOMER][NEUTRAL] But then we also sent in a claim for Jennings.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause I have one of them here that was processed on.
[AGENT][NEUTRAL] [PII], and it was, um, yeah, paid out on [PII].
[AGENT][NEUTRAL] It paid out for $432.83.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] 432 83. And was that for um Samsung? Was that for the MD?
[AGENT][NEUTRAL] Let's see, let me pull the image.
[AGENT][NEUTRAL] And if the doctor's name on there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, this one is for [PII].
[CUSTOMER][NEUTRAL] That's for [PII], OK, that's the CRNA.
[CUSTOMER][NEUTRAL] OK, so that one just processed, um, and can I get that claim number?
[AGENT][NEUTRAL] Yes, ma'am. The claim number is 3584781.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 4781 OK and do you have a claim on file at all for for uh [PII]?
[AGENT][NEUTRAL] Yes, one moment. There is one claim that's pending. Let me look at this image.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, this is the one that's on file for Samsung and um please allow 3 to 5 business days for this one to be processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and for the one that has paid out for the 432 83, is that an EFT or is that a um paper check?
[AGENT][NEUTRAL] It's a single paper check and the check number is.
[AGENT][NEUTRAL] 2036897.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Did you say 203-68997?
[AGENT][NEUTRAL] Yes, ma'am. That's the check number.
[CUSTOMER][NEUTRAL] OK, and that was recently mailed out. OK, alright, great, and if I could please just get your name and I'm sorry, the spelling of your first name and a reference number, excuse me.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, the reference number is my name and today's date. Um, my name is [PII]. It's spelled [PII] My last initial is [PII], and today's date is the reference number. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that's it for today. Thank you.
[AGENT][POSITIVE] Mhm. I thank you, [PII], for calling ATL. You have a great day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye bye.