AccountId: 011433970860
ContactId: 7d4039b7-5b8f-4eb9-91a8-9dd6b120bffa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 529739 ms
Total Talk Time (AGENT): 115864 ms
Total Talk Time (CUSTOMER): 243222 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/7d4039b7-5b8f-4eb9-91a8-9dd6b120bffa_20250320T19:47_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. This is [PII] and last initial is [PII], and I'm calling for Florida Home and Care LLC to check on additional information about a claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes.
[AGENT][NEUTRAL] And do you have a call reference number?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yes, it's uh [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[CUSTOMER][NEUTRAL] It's 01762065.
[AGENT][NEUTRAL] Thank you, [PII]. Hold on one moment please.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Yes, sure.
[CUSTOMER][NEUTRAL] And the ID is K as in Kilo P as in Papa.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you were just needing claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can look that up for you. What date of service was it for?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] And the build out.
[CUSTOMER][NEUTRAL] It's $298.
[CUSTOMER][NEUTRAL] How are you?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][POSITIVE] Yeah, sure. Take your time.
[AGENT][NEGATIVE] OK, we did receive the claim. It was denied.
[CUSTOMER][NEUTRAL] 440,810.
[AGENT][NEUTRAL] This policy canceled 31 of 23.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Absolutely
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Physician good services.
[CUSTOMER][NEUTRAL] Uh, hi, [PII], this is [PII] calling for Freedom Care to check on additional information that has been denied. Please note this call. Uh, just a moment. So the policy has been canceled on, uh, [PII] [PII], correct?
[AGENT][NEUTRAL] Is there anything else you needed?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So the member is not active for this policy, OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So could you please provide me the member effective date and the term date for this?
[AGENT][NEUTRAL] 81 of 19.
[CUSTOMER][NEUTRAL] $86.
[AGENT][NEUTRAL] To 31 of 23.
[CUSTOMER][POSITIVE] OK, thank you so much for this, and could you please provide me the corrected claim filing limit?
[AGENT][NEGATIVE] We do not have timely filing.
[CUSTOMER][POSITIVE] OK, OK, thank you so much for that and uh thank you so much for that. And can, could you please provide me the call reference? OK, thank you so much for this, and I have one more claim. Can you please help me with that? Uh, yes.
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name and today's date.
[AGENT][NEUTRAL] Is it on a different policy?
[AGENT][NEUTRAL] Hold on one moment, please.
[CUSTOMER][NEUTRAL] Yes, sure.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] by
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what's the next policy?
[CUSTOMER][NEUTRAL] It's 02514584.
[AGENT][NEUTRAL] Patient's name?
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] On which date
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] Data service
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] This is for dental.
[CUSTOMER][NEUTRAL] No, it's for medical.
[AGENT][NEUTRAL] OK, hold on one moment. You got the wrong policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] like.
[CUSTOMER][NEUTRAL] So the claim number.
[CUSTOMER][NEUTRAL] It's 4
[CUSTOMER][NEUTRAL] 30482.
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] The correct policy number for their medical policy is 02.
[AGENT][NEUTRAL] 514582.
[CUSTOMER][NEUTRAL] So you need uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Me too.
[CUSTOMER][NEUTRAL] seeing
[CUSTOMER][NEUTRAL] 14.
[AGENT][NEUTRAL] What was the total charge?
[CUSTOMER][NEUTRAL] And see
[CUSTOMER][NEUTRAL] It's $578.
[AGENT][NEUTRAL] And what was one of the uh procedure codes on that bill?
[CUSTOMER][NEUTRAL] Yes, just a moment. Yes, it's uh 99385.
[CUSTOMER][NEUTRAL] And the second one is 90715.
[CUSTOMER][NEGATIVE] The whole uh claim it is denying. It's the third sip it is 90471.
[CUSTOMER][NEUTRAL] 35
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, we did get the claim in.
[CUSTOMER][NEUTRAL] That.
[AGENT][NEUTRAL] On procedure code 99385, we paid $75.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] The other two lines were denied.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh that's.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yes, sure.
[AGENT][NEUTRAL] This policy does not provide benefits for vaccines and immunizations or the administration of the injections. So those procedure codes are not covered.
[CUSTOMER][NEUTRAL] 259.
[CUSTOMER][NEUTRAL] Bye
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for this. So the, both the CPDs which are the remaining one, it does not provide the vaccine and immunations, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much for this and there is no uh correct filing for this?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. Thank you so much for this. And uh is there any uh thank you so much. Uh, so could you provide me the call reference for this or uh it will be the same as your name and the date, correct?
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][POSITIVE] Thank you so much for this and have a nice day, [PII].
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a good day as well. Bye-bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.