AccountId: 011433970860
ContactId: 8170ea45-36dc-49c8-bbf9-584b8f00be7e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 635260 ms
Total Talk Time (AGENT): 190361 ms
Total Talk Time (CUSTOMER): 181114 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/8170ea45-36dc-49c8-bbf9-584b8f00be7e_20250507T13:30_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from provider's office to check on our claims.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Yeah, just one time.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yeah, the contact number is [PII]. It's a direct line, my extension. And for the policy number, it's 60801.
[AGENT][NEUTRAL] OK, that's our payer ID. Do you have the insurance ID card there with you?
[CUSTOMER][NEUTRAL] Yeah, let me check on that. Just give me a moment.
[AGENT][NEUTRAL] You're looking for the policy cert number? It should start with a 01 or a 02?
[CUSTOMER][NEUTRAL] OK. And this is your payer ID number, right? OK. Just give me a moment.
[CUSTOMER][NEUTRAL] Actually, the claims have been filed with the same member ID that is which I provided you earlier.
[AGENT][NEUTRAL] Do you have the member's ID card there with you?
[CUSTOMER][NEUTRAL] Just give me a moment.
[CUSTOMER][NEUTRAL] No, there is no members ID code on my end.
[AGENT][NEUTRAL] Do you have the full social?
[CUSTOMER][NEUTRAL] Yeah, let me check on that.
[CUSTOMER][NEUTRAL] The, yeah, it's, I do have the Social Security number. That is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And what is the member's first and last name?
[CUSTOMER][NEUTRAL] The member's first and last name is [PII], and for date of birth, that is [PII].
[AGENT][NEUTRAL] You said the first and last name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] No, it's [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] No, no, no. It's [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so nothing came up with the social. I'm getting ready to check with the first and last name now.
[AGENT][NEUTRAL] And do you have a claim number?
[CUSTOMER][NEUTRAL] Yeah, I do have the policy number. Yeah, I do have the policy number. Could you please check on that with the policy number?
[AGENT][NEUTRAL] If this is
[CUSTOMER][NEUTRAL] It's uh
[AGENT][NEUTRAL] Is it a different policy number than the one you gave?
[CUSTOMER][NEUTRAL] Yeah, for the same member ID.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what policy number do you have?
[CUSTOMER][NEUTRAL] It's uh.
[CUSTOMER][NEUTRAL] Yeah, it's 02556263.
[AGENT][NEUTRAL] OK, that's the number I was looking for. Hold on one moment.
[AGENT][NEUTRAL] And you've already verified the member's date of birth. Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service, um, and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yeah, the date of service is uh [PII] for the billed amount that is, just give me a moment.
[CUSTOMER][NEUTRAL] It's for the bill amount $526 even.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, the
[CUSTOMER][NEUTRAL] Name of the provider's office. It's Florida Hospital Physician Group.
[AGENT][NEUTRAL] Thank you for that. So we received the claim originally in February and then um it was resubmitted also in February where
[CUSTOMER][NEUTRAL] Can I have the date?
[AGENT][NEUTRAL] I'm asking you a question. Hold on one moment. Were you needing the original claim or the duplicate?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, I was checking on the claim that was submitted on [PII].
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, actually, we did submit the claim on [PII].
[AGENT][NEUTRAL] OK, so the original claim was received on [PII], the duplicate was received on [PII]. Which one would you like the claim status for or or both?
[CUSTOMER][NEUTRAL] Yeah, go ahead with the, the last one. I mean, the most recent client, I mean the duplicate.
[AGENT][NEUTRAL] We received a duplicate on [PII].
[AGENT][NEUTRAL] The claim number is 356.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 882 9.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied as a duplicate.
[CUSTOMER][NEUTRAL] Duplicate to the original claim, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Just give me a moment.
[CUSTOMER][NEUTRAL] Can I have the original claim number?
[AGENT][NEUTRAL] 356-457 5.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] May I know what is the status of that original claim?
[AGENT][NEUTRAL] OK, so the claim was received on [PII].
[AGENT][NEUTRAL] On [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] May I know who is the primary?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] It's showing as United Healthcare.
[CUSTOMER][NEUTRAL] OK, just give me a moment.
[CUSTOMER][NEUTRAL] Let me check whether we do found any other UV on that.
[CUSTOMER][NEUTRAL] Just bear with me a moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just give me a moment on that. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know how do we, how we are able to submit uh primaries yearly whether it's through our mail.
[AGENT][NEUTRAL] Um, you can fax it, you can mail it, or you can send it electronically. Which one would you prefer?
[CUSTOMER][NEUTRAL] Um, just bear with me a moment, let me check on that, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, can I have the possible ways to submit that? Can I have the fax number as well as the mailing address?
[CUSTOMER][NEUTRAL] As well as uh the portal.
[AGENT][NEUTRAL] They need them all. OK. So our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's uh um APO claims department?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Our payer ID is 60801.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And our fax number is [PII].
[AGENT][NEUTRAL] Attention APL claims department.
[CUSTOMER][NEUTRAL] OK. Can I have the timely filing limit?
[AGENT][NEUTRAL] There's no timely filing as long as the policy was active on the date of service, you can file at any time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got that. And can I have your card reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name on today's date, and that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Mhm. Thank you.
[CUSTOMER][POSITIVE] Thank you for that.
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, got it, [PII].
[AGENT][POSITIVE] Alright, well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Yeah, you too.