AccountId: 011433970860
ContactId: 7e6d1909-0d73-4ad0-9620-5e1c9cbcf43b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 614369 ms
Total Talk Time (AGENT): 183654 ms
Total Talk Time (CUSTOMER): 219636 ms
Interruptions: 5
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/7e6d1909-0d73-4ad0-9620-5e1c9cbcf43b_20250410T13:02_UTC.wav
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[AGENT][POSITIVE] Good morning.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Good morning. This is [PII].
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. And I'm calling for Florida Women Care check on additional information about the claim attachment and I please know this call will be monitored and recorded for quality and training purposes. I have already checked your reported.
[AGENT][NEUTRAL] OK, [PII], so you're wanting to get additional information on a denied claim and you have.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] I've gotten the explanation of benefits from our portal.
[CUSTOMER][POSITIVE] Yes, I got it.
[AGENT][POSITIVE] Yes ma'am. I can help you with that and [PII], what is your callback number, please?
[AGENT][NEUTRAL] OK. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes. It is [PII]. That is my extension. It is a direct line.
[AGENT][NEUTRAL] Thank you and the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Member's policy number is
[CUSTOMER][NEUTRAL] 01639192 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And any information provided today [PII] would be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Patient's first name is [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you one
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Where
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And what is the data service and total.
[CUSTOMER][NEUTRAL] Date of service is February. Yes, it is [PII].
[AGENT][NEUTRAL] Built in Mount Mary.
[AGENT][NEUTRAL] Uh-huh. Total bill amount.
[CUSTOMER][NEUTRAL] $75 even.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] It's not
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] What is the claim number?
[CUSTOMER][NEUTRAL] Claim number is
[CUSTOMER][NEUTRAL] 358-049-0
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And again, what is the total bill amount on this claim because what you gave me does not match this claim number.
[CUSTOMER][NEUTRAL] OK, let me check it out. It is $76 even.
[CUSTOMER][NEUTRAL] 5789.
[AGENT][NEUTRAL] OK, so that is not the billed amount on the claim number that you're giving me.
[CUSTOMER][NEUTRAL] It is $909 even, is it right?
[AGENT][NEUTRAL] How
[AGENT][NEUTRAL] Lunch
[CUSTOMER][NEUTRAL] $909 even.
[AGENT][NEUTRAL] No, ma'am, I do not have a claim on file for this number for that data service 2-19-2025 in either one of those two billed amounts.
[CUSTOMER][NEUTRAL] OK. So, as for the claim, what is the status of claim number? What is the status of the claim? I have the reference number for this. Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the provider facility name and tax ID number?
[CUSTOMER][NEUTRAL] So provider's facility name is?
[CUSTOMER][NEUTRAL] Florida Women Care and
[CUSTOMER][NEUTRAL] Tax ID number is [PII].
[AGENT][NEUTRAL] OK, thank you. So let me look at this claim because if you're giving me or not what is on this, what is in my system for this claim. So just one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] On
[AGENT][NEUTRAL] OK, so here's my, um, let's see, one moment.
[CUSTOMER][NEUTRAL] The same number is 8501.
[CUSTOMER][NEUTRAL] Followed by
[AGENT][NEUTRAL] OK, so on the total claim this state of service, is the $75 what was remaining from her primary, that's not the total on the claim itself.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So what is the status of the claim?
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What is the status of the claim?
[AGENT][NEUTRAL] What is the total bill amount, the correct total billed amount on the claim, not.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The balance from the primary.
[CUSTOMER][NEUTRAL] I don't have the.
[CUSTOMER][NEUTRAL] I don't have to pay more. Is it $395.93?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It is not. No, ma'am.
[CUSTOMER][NEUTRAL] No, I don't have them. Should I provide you the claim number?
[AGENT][NEUTRAL] OK. On the explanation of benefits that you printed from our portal, it does have the remark code on page 2.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Crema code. Yes, it is D2N0119.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And then it also has the remark.
[CUSTOMER][NEUTRAL] D as in Delta.
[CUSTOMER][NEUTRAL] Yes, this service is not covered when performing in a doctor's office or clinic.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 4
[AGENT][NEUTRAL] That is correct, yes, ma'am. By the patient's policy.
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] So what is the exact reason of this?
[AGENT][NEUTRAL] I'm sorry, what was your question, [PII]?
[CUSTOMER][NEUTRAL] What is the exact reason of this denial or rejection?
[AGENT][NEGATIVE] That is the exact denial.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. So, what is the place of service for this?
[AGENT][NEUTRAL] I'm sorry, what? I can't.
[AGENT][NEUTRAL] Hear you. There's something in the
[CUSTOMER][NEUTRAL] What is the place of service for this?
[AGENT][NEGATIVE] Background and I'm not able to hear you very well.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] I'm still not understanding you.
[CUSTOMER][NEUTRAL] What is the place of service for this?
[AGENT][NEUTRAL] You would need to look on your claim form for this.
[CUSTOMER][NEUTRAL] OK. What is the correct mailing address?
[AGENT][NEUTRAL] The claims mailing address is the same as this one was sent to [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] What is
[CUSTOMER][NEUTRAL] And how about the corrected filing limit?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] There's no timely filing for a corrected claim and appeal.
[AGENT][NEGATIVE] You must be filed within 180 days from the date of it. Again, this service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Not covered, yes. And how about the reference number?
[AGENT][NEUTRAL] It's the reason for the denial for that code.
[AGENT][NEUTRAL] For the members
[CUSTOMER][NEUTRAL] Yes, and how?
[CUSTOMER][NEUTRAL] I have the reference number for this.
[AGENT][NEUTRAL] Reference number is my name that I gave along with today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Is there anything else, [PII], that I can help you with? Oh, yes, ma'am. You too.
[CUSTOMER][POSITIVE] Thank you. Have a great day.
[CUSTOMER][POSITIVE] No, thank you. Yeah, bye. Thank you. Have a great day.
[AGENT][NEUTRAL] OK, well
[AGENT][POSITIVE] You too and thank you again for calling APO.