AccountId: 011433970860
ContactId: 986503a8-ac6a-4a25-aef0-a94e68e3659b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 243389 ms
Total Talk Time (AGENT): 99312 ms
Total Talk Time (CUSTOMER): 75662 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/986503a8-ac6a-4a25-aef0-a94e68e3659b_20250204T20:22_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from a provider's office, checking up on the claim status.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, that is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, may I have your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Thank you, and [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] 1
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure, that is going to be.
[CUSTOMER][NEUTRAL] 01816856
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yes. [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] 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 for the claim you like me to take a look at?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] And the total charge amount is $18,928 and even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] Can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's a Florida Northwest Hospital.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim number is 352-434-2.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK. As I can see from my end, we have already faxed you the primary of the multiple times which was sent on [PII]. Also on [PII], also on [PII]. Can you just check from here and let me know whether have you received that or not?
[AGENT][NEGATIVE] We received one claim on [PII] and that was denied as a duplicate requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK. Yes, you haven't received it, right?
[AGENT][NEUTRAL] I'm waiting for the documents to come up now so I can confirm what was sent. Hold on one moment.
[AGENT][NEGATIVE] Yeah, so this is just one page. It's the claim form. There is no explanation of benefits. I do see in box 80 where it says it's attached, but it's just one page, there's nothing attached.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can you confirm the fax number? Is that [PII]?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. May I know your name and timely filing limit?
[AGENT][NEUTRAL] Sure, so there's no timely filing limit and my name is [PII].
[CUSTOMER][NEUTRAL] Do you have any call reference number?
[AGENT][NEUTRAL] There's no call reference number, but you can use my name and today's date.
[CUSTOMER][NEUTRAL] Can you repeat the fax number one more time?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. Thank you, [PII], and hope you have a nice day. Goodbye.
[AGENT][POSITIVE] Thank you, [PII], you also, and thanks for calling APL. Bye-bye.