AccountId: 011433970860
ContactId: 803a4104-355a-444f-b715-372b250ecc19
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 599549 ms
Total Talk Time (AGENT): 226069 ms
Total Talk Time (CUSTOMER): 165116 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/803a4104-355a-444f-b715-372b250ecc19_20250508T13:22_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm looking for a medical claim status.
[AGENT][NEUTRAL] OK, [PII], you need claim status. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status?
[CUSTOMER][NEUTRAL] Two claims
[AGENT][NEUTRAL] For different patients or same patient multiple dates of service, OK?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So I can help you with that, and [PII], you will use my name that I gave you along with today's date as your call reference number for each one. Also, [PII], any information provided will be a verification of benefits and not a guarantee of payment. And lastly, if the claims are on file and you need a copy of the explanation of benefits, once you have the claim number, you can print those explanation of benefits from our portal by going to secured.
[CUSTOMER][NEUTRAL] Different.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is your first patient's policy number, please?
[CUSTOMER][NEUTRAL] Yes, 02467155 M as in Mike, L as in Lima, number 8.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII], last name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount please.
[CUSTOMER][NEUTRAL] Yes, [PII] and the total bill amount is $174,210 even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you said the date of service is [PII] for $174,210. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And again, OK, so just one moment.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I have the claim number. Do you need the claim number?
[AGENT][NEUTRAL] Give me just a moment to look at something on this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so, yes, sir, I have the claim.
[AGENT][NEGATIVE] The most recent we've received this more than once. The most recent one was denied as a duplicate and the original was denied because we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yes. Uh, the primary will be previously faxed on [PII]. fax number is 877.
[AGENT][NEUTRAL] Yeah, we've
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] [PII]. It's your correct fax number?
[AGENT][NEUTRAL] Yes, with a 1 in front of the 877.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] Yes, sir, but we did not receive that.
[AGENT][NEGATIVE] For whatever reason, it was not received.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, do you have the claim receive and process date?
[AGENT][NEUTRAL] The original claim was received. Is that the information you're wanting?
[AGENT][NEUTRAL] Or the duplicate. Original received [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Virgin.
[AGENT][NEUTRAL] Processed on [PII].
[CUSTOMER][NEUTRAL] OK. Uh, I have one claim number. The claim number is 3546727. Is that correct? It's the original claim number?
[AGENT][POSITIVE] That is correct, yes, sir.
[AGENT][NEUTRAL] Correct, and all we need to have sent is the explanation of benefits. We do not need to claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, this time, I submit through your mailing address. May I have your mailing address?
[AGENT][NEUTRAL] It is the same as claims. What do you show for the claims address?
[CUSTOMER][NEUTRAL] [PII]. Is that correct?
[AGENT][NEUTRAL] And after that, it's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, any time limit for resubmit this claim? Sorry, primary OB?
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, shall I move to next claim?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And again, that we do have that portal that I gave you if you need a copy of that.
[AGENT][NEUTRAL] Alright, so one moment please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what is the next policy number, [PII]?
[CUSTOMER][NEUTRAL] Yes, uh 01978557. M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII], and date of birth is [PII].
[AGENT][POSITIVE] Thank you
[AGENT][NEUTRAL] Data service and total bill amount.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And the total and the total charges.
[CUSTOMER][NEUTRAL] Uh, $13,715 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this claim was received on 131 denied 23.
[AGENT][NEUTRAL] The claim number is 3558917.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And this was denied for the same reason. We're in need of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, this one we send uh.
[AGENT][NEUTRAL] And that has not been.
[CUSTOMER][NEUTRAL] Yes. Uh, this one also we send on [PII]. We submit to the mailing address you did not receive?
[AGENT][NEUTRAL] No, sir.
[AGENT][NEUTRAL] No, sir. We did not we have not received an explanation of benefits.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. Uh, this time I submit to fax. May I have your fax number?
[AGENT][NEUTRAL] The same as the one I gave you. [PII].
[AGENT][NEUTRAL] And give me a moment to look at and what is the name of the first off what is the name of the provider group which this claim is for?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah. Yes, it's at Florida Mercy Hospital.
[AGENT][NEGATIVE] Yes, sir. No, we have not received that.
[CUSTOMER][NEUTRAL] Oh, OK. Uh, attention to claims department.
[AGENT][NEUTRAL] And make sure to send the fax. That is correct.
[CUSTOMER][NEUTRAL] OK. Yeah.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, you, could you spell your name, please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Thank you for your assistance. Have a good day.
[AGENT][POSITIVE] And you would you. You're welcome. Yes, sir. Well, if that is all I can help you with, thank you again for calling APL and I hope that you have a very nice day also.
[CUSTOMER][POSITIVE] Yeah, yeah, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Hi, [PII].
[CUSTOMER][NEUTRAL] Yeah, bye.