AccountId: 011433970860
ContactId: 8208bab2-3c57-4cdf-819f-cc5011826042
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 882679 ms
Total Talk Time (AGENT): 301183 ms
Total Talk Time (CUSTOMER): 332985 ms
Interruptions: 5
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/8208bab2-3c57-4cdf-819f-cc5011826042_20250523T14:18_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Uh, hi, this is [PII] calling from the product's office to check claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Yes, I can help you with that, [PII] and what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And how many points do you have to check status on?
[CUSTOMER][NEUTRAL] Uh, I have 4 claims.
[AGENT][NEUTRAL] Are they for 4 different patients or 1 patient and multiple dates, so 1 data service each?
[CUSTOMER][NEUTRAL] Yes, different patient.
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] No, no, 4 different patients and different date of service, but under the same tax ID, yeah.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can help you with this. Now, [PII], my name is [PII] and you're going to use my [PII]
[CUSTOMER][NEUTRAL] Can you spell me your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you will use my, uh-huh, you will use my name and today's date as each of your call reference numbers.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Also, [PII], any information that I provide for you on any of the claims will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And lastly, if we do have the claims on file once I give you the claim number if you need a copy of that explanation of benefits, you should be able to go to our portal and print that yourself and the website to do that is secured.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your first patient's policy number, [PII]?
[CUSTOMER][NEUTRAL] Sure. The first policy number is 1,451,720.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Welcome.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. The patient's first name is uh [PII], and the last name is uh [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Yeah. Welcome.
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] And what is your patience, uh, what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Sure, [PII]. The date uh date of service is [PII]. Total chargeable amount is $334 even.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Welcome.
[AGENT][NEUTRAL] OK, so this claim was received. The received date on the claim is [PII].
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEGATIVE] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 354-829-3.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the reason for the denial states, please provide copies of your explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] N
[CUSTOMER][NEUTRAL] Benefit, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, and do you have a fax number or mailing address that you sent?
[AGENT][NEUTRAL] Uh, both. The claims mailing address is where you would send it if you're mailing it, and our fax number is [PII]. Attention claims.
[CUSTOMER][NEUTRAL] Just a second. Can you please confirm once again the fax number is [PII], correct?
[AGENT][NEUTRAL] [PII] are the last four numbers.
[CUSTOMER][NEUTRAL] OK, OK, [PII]. Sorry.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, and attention.
[AGENT][NEUTRAL] Claims department.
[CUSTOMER][NEUTRAL] Attention.
[CUSTOMER][NEUTRAL] OK, just a second. I can claims department.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] At.
[CUSTOMER][NEUTRAL] And what is it timely filing?
[AGENT][NEGATIVE] No timely filing limit.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] There is not a timely filing limit?
[CUSTOMER][NEUTRAL] No time time? OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, can you please just confirm the member is eligible for data of service?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you have an effective date?
[AGENT][NEUTRAL] The policy effective date.
[AGENT][NEUTRAL] Is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And it's still active?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, [PII], thank you.
[CUSTOMER][NEUTRAL] Still
[CUSTOMER][POSITIVE] Now I'm completed this one. So are you ready for the next one?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Sure. Take your time.
[AGENT][NEUTRAL] OK. And the next member's policy number?
[CUSTOMER][NEUTRAL] Sure. Next policy number is 00994160.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] come.
[AGENT][NEUTRAL] And what is the data service and total bill amount, please?
[CUSTOMER][NEUTRAL] Sure. The date of service is uh [PII] and the total chargeable amount is $824 even.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Welcome.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Keep the
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] OK, so this claim was also received this claim was received on [PII].
[AGENT][NEGATIVE] And it was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] The claim number is 355.
[CUSTOMER][NEUTRAL] And for the same reason?
[AGENT][NEUTRAL] 4804 and it was also denied for the same reason as the last one we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Got it. And the fax number is also the same, correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, it's OK.
[CUSTOMER][NEUTRAL] And can you please provide me eligibility member is eligible for data of service?
[AGENT][NEUTRAL] The policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Hm selective.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][POSITIVE] I'm completed this one also. Whenever you're ready for the next one, let me know.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Sure. The next member policy number is uh mm.
[CUSTOMER][NEUTRAL] 01669817.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] I think it was incredible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Insurance front back, front card.
[AGENT][NEUTRAL] And your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh sure. Patient first name is [PII] and the last name is [PII]. Date of birth is uh [PII].
[AGENT][NEUTRAL] OK, thank you. And the date of service and total bill amount, please.
[CUSTOMER][NEUTRAL] Uh yeah, sure. The date of service is uh [PII], and the total chargeable amount is $440 even.
[AGENT][NEUTRAL] 440. Is that correct?
[CUSTOMER][NEUTRAL] Yes, correct, [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and again, you said the data service is [PII]. Is that correct?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] OK, so we do not have the claim on file for that data service and build them out.
[CUSTOMER][NEUTRAL] OK, got it. So we need to submit claim with primary will be correct?
[AGENT][NEUTRAL] Yes, we will need the claim and the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Sure. So we can submit uh this one also on your fax number, both claims and, OK. Can you please verify me the member is eligible for the service?
[AGENT][NEUTRAL] You can, mhm.
[AGENT][NEUTRAL] This policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] [PII] and it's still active?
[AGENT][POSITIVE] Yes, sir. Correct.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] And there is no timely filing, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] So I'm completed on this one also just I have last one. Whenever you're ready let me know.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] I will, thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and the last policy number, please.
[CUSTOMER][NEUTRAL] Sure. The policy number is 1221549.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Yeah. Welcome.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient first name is [PII] and the last name is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the date of service and total bill amount please.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] D of service is [PII]. Total chargeable amount is $340 even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][POSITIVE] You're welcome. Yeah.
[AGENT][NEUTRAL] OK, and there is also no claim on file for data service for [PII].
[CUSTOMER][NEUTRAL] OK. Can you please verify me the member is eligible for data service?
[AGENT][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] And just let me one thing and just confirm for uh this um you are a primary for this uh claim processing or you are a secondary?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] No, sir. We are not a major medical carrier. This is a supplemental policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. So you're not a primary insurance, correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please verify my eligibility?
[AGENT][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] So this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Still active?
[AGENT][NEUTRAL] It is, yes.
[CUSTOMER][NEUTRAL] OK. Can you please just verify me, uh, who is the primary insurance? Do you have any information about in your system?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I showed that for the father's employer.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It shows as Florida Blue is the primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Florida Blue BCBS Blue Cross Blue Shield, correct?
[AGENT][POSITIVE] Uh, yes, I believe that is correct.
[CUSTOMER][POSITIVE] Oh, OK, [PII]. OK. OK, [PII], thank, thank you for your assistance. Have a good day. Bye. No, thank you, thank you for your assistance and happy weekend. Bye.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Well, you're welcome. Is there anything else I can help you with today, [PII]?
[AGENT][POSITIVE] Well, you're uh happy weekend to you as well and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.