AccountId: 011433970860
ContactId: 8b6b0436-0a0b-4336-b297-5f20c3936144
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 452809 ms
Total Talk Time (AGENT): 185376 ms
Total Talk Time (CUSTOMER): 142323 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/8b6b0436-0a0b-4336-b297-5f20c3936144_20250521T20:00_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. I'm calling from Florida Mercy Hospital. I'm calling regarding a patient and a denial that we've received.
[AGENT][NEUTRAL] OK [PII], are you needing clarification on a denied claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I'm sorry, did you say [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, just getting that pulled up. It takes a second.
[CUSTOMER][NEUTRAL] Having some issues with my system today. I apologize.
[AGENT][NEUTRAL] Oh, that's OK. I understand that can happen.
[CUSTOMER][NEUTRAL] Alright, I have 0246.
[CUSTOMER][NEUTRAL] 5902.
[AGENT][NEUTRAL] OK, thank you. Give me a moment please to get the member's information pulled up.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, mostly [PII].
[CUSTOMER][NEUTRAL] Clavijo Geminis [PII].
[AGENT][NEUTRAL] What is the first name?
[CUSTOMER][POSITIVE] Oh my goodness.
[CUSTOMER][NEUTRAL] I have it as [PII].
[AGENT][NEUTRAL] OK, so that information does not match our system records.
[CUSTOMER][NEUTRAL] Um, it's a newborn baby, so it might be under there.
[CUSTOMER][NEUTRAL] The parent's name is [PII] is what mom's name is.
[AGENT][NEUTRAL] OK. Again, the claim does not have been, we do not have a [PII] listed that doesn't match our records.
[AGENT][NEUTRAL] Is they, do they have another name listed?
[CUSTOMER][NEUTRAL] OK, yeah, because it's the newborn, so they probably haven't.
[CUSTOMER][NEUTRAL] This, um, [PII] and then I said that the first thing we have is [PII]. We have moms team listed as uh [PII].
[CUSTOMER][NEUTRAL] Um, but they don't have like a father's name or anything.
[AGENT][NEUTRAL] OK, so the.
[AGENT][NEUTRAL] The [PII].
[AGENT][NEUTRAL] What does that show on?
[CUSTOMER][NEUTRAL] What does what say? I'm sorry?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] The denial.
[AGENT][NEUTRAL] Correct, because that is the name that's, that is the name.
[CUSTOMER][NEGATIVE] So the denial
[AGENT][NEUTRAL] That is on this policy.
[AGENT][NEUTRAL] Again, there is no [PII] listed.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Let me look and see.
[CUSTOMER][NEUTRAL] Yeah, it just says the insured is Mom [PII]. Claimant is [PII], which is the patient's last name. We have a list of his last name.
[AGENT][NEUTRAL] And we have that as the first name and [PII].
[CUSTOMER][NEUTRAL] Um, I have a claim number is 358.
[AGENT][NEUTRAL] Yes, and we have [PII] as the last name and [PII] as the first name.
[CUSTOMER][NEUTRAL] [PII] is the first name? OK.
[AGENT][NEUTRAL] That is according to our records, yes.
[CUSTOMER][NEUTRAL] OK, let me update that.
[CUSTOMER][NEUTRAL] OK, I went I thought updated. So it says to provide copies of explanation of update. I'm not sure what that means.
[AGENT][NEUTRAL] OK, and then
[AGENT][NEUTRAL] OK, so just one moment.
[AGENT][NEUTRAL] So again, any information [PII] that I provide will be a verification of benefits and not a guarantee of payment. What is the date of service?
[AGENT][NEUTRAL] And build them out, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Through [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The total bill amount for.
[AGENT][NEUTRAL] Through the [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just like the total bill amount was $7,036.
[AGENT][NEUTRAL] 7,036. Is that correct?
[CUSTOMER][NEUTRAL] 7,036.
[AGENT][NEUTRAL] OK, and do you already have the claim number? or do you need that?
[CUSTOMER][NEUTRAL] Um, I have claim number 3,589,470.
[AGENT][NEUTRAL] OK. Yes, ma'am, that is the correct claim number and yes, that claim has been denied at this point and the reason for the denial is on page 2 of your explanation of benefits. It states, please provide copies of your explanation of benefits from your primary insurance carrier because this is a supplemental policy.
[CUSTOMER][NEUTRAL] OK, it just says explanation of updates, so.
[AGENT][NEUTRAL] Oh, yeah.
[AGENT][NEUTRAL] That's what it says in the system or you're looking at the actual EOB?
[CUSTOMER][NEUTRAL] The denial that they sent us, it just says remark.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] A code number and then provides have explanation of update and I'm like wait, what does that mean?
[AGENT][NEUTRAL] Oh, I don't know. Um, so that's something that someone there at the hospital entered?
[AGENT][NEUTRAL] Because the actual explanation of benefits.
[CUSTOMER][NEUTRAL] No, that's what came over on the form.
[AGENT][NEUTRAL] OK, I'm not sure because I'm looking at the explanation of benefits and it reads exactly.
[AGENT][NEUTRAL] How I just read it to you. Please provide copies of your explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Do you know who the primary insurance carrier is?
[AGENT][NEUTRAL] According to our records, the mother's primary insurance is through United Healthcare.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and I'm sorry, your first name?
[AGENT][NEUTRAL] Again, my name is [PII] and you will use my name along with today's date as the call reference number if you need one [PII] and then [PII], we also have a portal that you should be able to print this explanation of benefits from.
[AGENT][NEUTRAL] And the website for that portal is located at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you so much you have a great day.
[AGENT][POSITIVE] Oh, yeah. I hope you have a great day too, if that's all I can help you with, and thank you again for calling APL.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.