AccountId: 011433970860
ContactId: 99acd455-76b1-4603-83c9-15d497b4aae5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 380079 ms
Total Talk Time (AGENT): 118689 ms
Total Talk Time (CUSTOMER): 80557 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/99acd455-76b1-4603-83c9-15d497b4aae5_20250116T21:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi there. My name is [PII] calling from the provider's office and I'm checking on your claim status.
[AGENT][NEUTRAL] Hi [PII], I can help you with claim status. Can you please give me your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Patient is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then what is [PII]'s um.
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then what is the patient's policy number?
[CUSTOMER][NEUTRAL] Policy number is
[CUSTOMER][NEUTRAL] 0244.
[CUSTOMER][NEUTRAL] 0231 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you. And then what's the patient's date of service?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And the charge amount please?
[CUSTOMER][NEUTRAL] $2,011 even.
[AGENT][NEUTRAL] OK, and then what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] $500.
[AGENT][NEUTRAL] Thank you. And then what is the name of the facility you're calling for, [PII]?
[CUSTOMER][NEUTRAL] I'm calling from Naples Community Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I pull this claim up for you and I'll be right back sir.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me [PII]. This is [PII] back with you again. So looking on uh Celine Torres data service is [PII]. I do not find a claim on file.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, is the member's policy active on the sort of service?
[AGENT][NEUTRAL] Let me look for you.
[AGENT][NEUTRAL] The effective date is [PII] and the policy is still active.
[CUSTOMER][NEUTRAL] OK. And what's the time for them to book the claim?
[AGENT][NEGATIVE] We don't have a timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] May I have the address to submit the claim?
[AGENT][NEUTRAL] Yes, the address is [PII].
[AGENT][NEUTRAL] And that is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] And the zip code is?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And is this uh Medicare supplement policy?
[AGENT][NEUTRAL] OK, and this is just to verify coverage. It's not a guarantee of payment. This policy is a supplemental insurance policy that helps with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] So, so if, if the primary insurance was uh not Medicare, in that case, uh,
[CUSTOMER][NEUTRAL] Can we bill the claim to APL?
[AGENT][NEUTRAL] No, the claim has to be billed to the primary insurance first.
[AGENT][NEUTRAL] And then after the primary insurance pays their part, then you bill a secondary.
[CUSTOMER][NEUTRAL] OK. And the primary can be any payer, right? It, it is not mandatory to pay Medicare.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I missed your name. Can you please repeat?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] And may I have the reference number for this call?
[AGENT][NEUTRAL] Yes, sir. You can use my name and today's date.
[CUSTOMER][POSITIVE] OK. So thank you so much, [PII], and have a great day.
[AGENT][POSITIVE] You too, [PII]. Thank you for calling A.
[CUSTOMER][NEUTRAL] Bye.