AccountId: 011433970860
ContactId: 94b97618-894b-4775-ae9c-cb0db7c133dc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 386750 ms
Total Talk Time (AGENT): 114281 ms
Total Talk Time (CUSTOMER): 222087 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/94b97618-894b-4775-ae9c-cb0db7c133dc_20250429T16:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi this is [PII] with Broker Resources. How are you doing?
[AGENT][POSITIVE] I'm good. How are you, [PII]?
[CUSTOMER][NEUTRAL] I'm good thank you um so I have a [PII] with Accursure on the line um and she was calling in regards to group number 19145.
[CUSTOMER][NEUTRAL] Um, and one of the um group's employees, uh, submitted a claim and they were curious if that has been processed yet or not. Um, the policy number is 2486566.
[AGENT][NEUTRAL] OK, for [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I got him pulled up and you can send her over.
[CUSTOMER][POSITIVE] OK perfect thank you.
[AGENT][POSITIVE] Mhm. Thank you.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh hold on a sec I'm.
[CUSTOMER][NEUTRAL] I'm trying to, I'm trying to have her join. Hold on a sec.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], are you still there?
[CUSTOMER][POSITIVE] Yep I am. OK perfect I have um someone from the claims department that can help you with your questions OK? OK, thanks so much of course.
[AGENT][NEUTRAL] Hi, [PII]. This is [PII] I'm in the claims department.
[CUSTOMER][NEUTRAL] Hi, [PII]. How are you today?
[AGENT][POSITIVE] Hello. I'm good. How are you?
[CUSTOMER][NEUTRAL] Good good hey so this guy, um, I'm not sure if this is a different invoice. I think it may be, um, he sent back in March I talked to him on [PII] he actually um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh gosh, sorry, let me close some things so I can actually.
[CUSTOMER][NEUTRAL] I have too many things open right now. It's one of those days, um, OK, so he sent it a copy of his invoice from um.
[AGENT][NEUTRAL] I understand.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Emergency, emergency Medicine Services of Florida in the manner of 536-15. Looks like it was charged 938. [PII], what's that name? [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For 22 of 25 emergency room, emergency department visit. Um.
[CUSTOMER][NEGATIVE] And he called in because he thought he'd gone to an urgent care and then he got these huge bills and I ended up um.
[CUSTOMER][NEUTRAL] You know, giving him his APL information and APL said as long as it was outpatient services everything was gonna be paid um can you tell if this claim has been paid and if not can I forward to you the um.
[CUSTOMER][NEUTRAL] The ER
[CUSTOMER][NEUTRAL] Invoice or the invoices that he sent to us so that you can.
[CUSTOMER][NEUTRAL] Like have them processed.
[AGENT][NEUTRAL] Um, yes, ma'am. First, could you please verify his name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, hold on one second, let me get to that screen.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] His name is [PII].
[CUSTOMER][NEUTRAL] And his um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] His date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Yes, ma'am. And um yes, you can submit the claims because I don't show them on file. They never filed the claim with us. But yes, you can submit the claims. um mhm.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Well, it's not actual claims it's invoices from the provider, but will that work because it has like, you know, it has the charges, it has the adjustments by Signa and the amount owed.
[AGENT][POSITIVE] OK. Excellent.
[CUSTOMER][NEUTRAL] The facility
[AGENT][NEUTRAL] Yeah, actually, we would need that invoice. We would need his diagnosis code and you would need to make sure that the diagnosis code is on the invoice. Um, if it's not on there, you can contact the provider and have them send that information to you. And we will also use the EOP from the primary insurance company.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] For the date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What's the address where it goes to?
[AGENT][NEUTRAL] You can mail it in, you can fax it in, or you can file the claim online.
[AGENT][NEUTRAL] But let me give you the address. Um, the address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] In [PII] City, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, and what's the fax number?
[AGENT][NEUTRAL] The fax number is [PII] and please attention it to the claims department.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And um do you have the um oh my gosh, what is it called? I came out of a medical, medical background, but it's been a while. The um
[AGENT][NEUTRAL] And your ID.
[CUSTOMER][NEUTRAL] The electronic claims number payer ID thank you that's what I was looking for.
[AGENT][NEUTRAL] Yes, ma'am. It's 60801.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, alright, so the original provider can.
[CUSTOMER][NEUTRAL] Fax, mail or send it electronically on a um.
[CUSTOMER][NEUTRAL] CMS 1500, right?
[AGENT][NEUTRAL] Yes, that's correct. And along with it, um send the um EOB from the primary insurance, yes.
[CUSTOMER][NEUTRAL] The primary EOB.
[CUSTOMER][POSITIVE] Got you. OK, all right, I'll let them know. Thank you so much for checking EV. You have a great day.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] You do the same, [PII]. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] No, I think that's it.
[AGENT][POSITIVE] OK. Well, I thank you again, [PII] for calling ATL. You have a great rest of your day as well. Mm, bye.
[CUSTOMER][NEUTRAL] You too. Bye bye.