AccountId: 011433970860
ContactId: a0a8cf95-0e78-4020-88d0-b9d32a05b517
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 617849 ms
Total Talk Time (AGENT): 260724 ms
Total Talk Time (CUSTOMER): 512719 ms
Interruptions: 50
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/a0a8cf95-0e78-4020-88d0-b9d32a05b517_20250130T13:38_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. My name is [PII]. Can I help you?
[CUSTOMER][NEUTRAL] Good morning. Hi, this is [PII] calling from the provider's office to check the claim status. Can you repeat your first name, please slowly spell it out. Sure. My first name is [PII] OK.
[AGENT][NEUTRAL] First, sure. My first name is [PII]
[AGENT][NEUTRAL] First initial last name, [PII].
[CUSTOMER][NEUTRAL] Last name OK. My name is [PII], and last name is [PII].
[AGENT][POSITIVE] Thank you, [PII]. What is a good callback number?
[CUSTOMER][POSITIVE] Thank you, doctor. What is a good callback number?
[CUSTOMER][NEUTRAL] My callback number is [PII].
[AGENT][NEUTRAL] Thank you, Pascot. And the policy number for the patient, please.
[CUSTOMER][NEUTRAL] Thank you, and the policy number for the patient, please. Are you asking the member ID for the patient? Policy number means one so I'm told.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] En suite.
[CUSTOMER][NEUTRAL] The member ID is 02473288.
[AGENT][NEUTRAL] And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] And the patient's name and date of birth, please? Patient's name is uh
[CUSTOMER][NEUTRAL] Uh one second.
[CUSTOMER][NEUTRAL] Patient's name is um [PII]. And date of birth is uh [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] All right, thank you. And do you happen to have a claim number or date of service?
[CUSTOMER][NEUTRAL] OK, thank you. Do you happen to have a claim number or data service? Having data service.
[AGENT][NEUTRAL] And that date is?
[CUSTOMER][NEUTRAL] OK. Uh, the date of service is uh [PII].
[AGENT][NEUTRAL] What is the bill amount, please?
[CUSTOMER][NEUTRAL] What is the $909.
[AGENT][NEUTRAL] OK, thank you. And what is the facility name?
[CUSTOMER][NEUTRAL] OK, thank you and what is the facility name? What?
[AGENT][NEUTRAL] The facility name.
[CUSTOMER][NEUTRAL] The facility name.
[CUSTOMER][NEUTRAL] Uh, facility name is Holy Cross Hospital.
[AGENT][POSITIVE] All right, thank you. [PII], I can help you with that claim status. We actually received that claim on [PII].
[CUSTOMER][POSITIVE] All right, thank you, [PII]. I can help you with that claim status. We actually received that claim on [PII]. OK.
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] It was processed on [PII]. OK.
[AGENT][NEUTRAL] And it is pending for the primary EOB.
[CUSTOMER][NEUTRAL] And it is pending for the primary EOD.
[CUSTOMER][NEUTRAL] OK. You have not having the the primary for this claim?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEGATIVE] In my hand, there is no UOB received for this claim. I'm also called to you and ask for the delay of uh reason EOB.
[AGENT][NEUTRAL] EOBs are attainable on our portal at secured.
[CUSTOMER][NEUTRAL] The EOBs are attainable on our portal at secured. a.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] [PII]. Once you repeat again slowly, secured, it's secured SEC.
[AGENT][NEUTRAL] Sure, it's secured, SEC.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] It's a self-registration using the tax ID number and the patient's account number inbox 38 on the UBO4.
[CUSTOMER][NEUTRAL] It's a self registration using the tax ID number and the patient's account number inbox 38 on UBO4. OK, we have to register on this portal or directly to claim status for this number. Mhm you can check claim status you have access to the EOBs and you can also claim um submit claim documents online. OK, for this uh in my hand, my hand for this claim not showing EO.
[AGENT][NEUTRAL] And you can, mhm you can check claim status, you have access to the EOBs and you can also claim um submit claim documents online.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, having any reason for delay of EOB for this claim?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] No, we need the primary EOB. Have you got the major medical explanation of benefits?
[CUSTOMER][NEUTRAL] No, if we need the primary EOB, have you got the major medical explanation benefits?
[CUSTOMER][NEGATIVE] No, there is no explanation of benefits posted for this year. There is showing none.
[AGENT][NEUTRAL] Have you all submitted the claim? OK, have you all submitted the claim to Florida Blue?
[CUSTOMER][NEUTRAL] In in my hand. OK, have you submitted the claim to [PII]? Yes.
[AGENT][NEUTRAL] OK, so we need the EOB from [PII] Blue in order to complete the processing of our claim. We're secondary.
[CUSTOMER][NEUTRAL] OK, so we need the EOB from [PII] Blue in order to complete the processing of our claim. We're secondary. Uh, uh, uh, my primary is showing the the America Public Life having your contact number, that's why I'm call you're asking primly you will be for this claim for further cost of this claim.
[AGENT][NEUTRAL] Mm
[AGENT][NEGATIVE] That's right, we are not.
[AGENT][NEUTRAL] Yeah, we're not major medical. We are secondary.
[CUSTOMER][NEUTRAL] Yeah, we're not major medical, we are secondary.
[AGENT][NEUTRAL] So we need that primary EOD.
[CUSTOMER][NEUTRAL] OK, you are you asking primly you will be via NA we have to send which option through which option we have to send.
[AGENT][NEUTRAL] If the claim has not been submitted to [PII], it would need to be submitted to [PII].
[CUSTOMER][NEUTRAL] If the claim has not been submitted to [PII], it would need to be submitted to [PII]. What?
[CUSTOMER][NEUTRAL] each name
[AGENT][NEUTRAL] [PII] is their primary insurance.
[CUSTOMER][NEUTRAL] [PII] [PII] Oh, can you spell it? [PII] [PII]
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII] [PII]
[CUSTOMER][NEUTRAL] Spell it out [PII] OK.
[AGENT][NEUTRAL] [PII] [PII]
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And then [PII], [PII]
[CUSTOMER][NEUTRAL] [PII]. [PII] OK. [PII]. This is the primary insurance.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] [PII] for OK, [PII].
[AGENT][NEUTRAL] Is the name of the primary?
[AGENT][NEUTRAL] That's correct. [PII] for, you want me to spell it again?
[CUSTOMER][NEUTRAL] Yes, yes, OK, OK, uh, no, no, no, I'm understanding. In my hand it's showing the primary payer plan is commercial generic and uh uh uh calling in contact showing America public life and having your contact number. That's why I'm calling.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] You are with insurance?
[AGENT][NEUTRAL] We are secondary. We are American public life.
[CUSTOMER][NEUTRAL] Secondary means uh American. OK, you are American public life. Secondly, we, you have no you don't have you will be for this claim.
[AGENT][NEUTRAL] But we're not major medical.
[AGENT][POSITIVE] Yes, sir. Yes, sir. That's right.
[AGENT][NEUTRAL] We do not have a primary EOB that is correct.
[CUSTOMER][NEUTRAL] Yes. We have to submit primary OB to you or [PII].
[AGENT][NEUTRAL] If you, you would have to submit the [PII].
[CUSTOMER][NEUTRAL] If you, you would have to submit the Florida [PII] EOB to us once [PII] processes the claim.
[AGENT][NEUTRAL] EOB to us once [PII] Blue processes the claim.
[CUSTOMER][NEUTRAL] We have to submit to 2 and uh for also. We have to submit to primary to 2 insurances and only 1 insurance.
[AGENT][NEUTRAL] So, Florida Blue is the primary insurance.
[CUSTOMER][NEUTRAL] So Florida Blue is the primary insurance.
[AGENT][NEUTRAL] If y'all have not, if the claim has not been submitted to [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You would need to submit the claim directly to [PII].
[CUSTOMER][NEUTRAL] You would need to submit the claim directly to [PII]. OK.
[AGENT][NEUTRAL] Once they process the claim and have their EOB.
[CUSTOMER][NEUTRAL] Once they process the claim and have their EOB. OK, then you'll send Florida EOB to APL so we can complete the processing. OK, OK. Uh, we, if we submit the claim to Florida then process this claim and uh it will be sent to you for for for the process of the your to APL.
[AGENT][NEUTRAL] Then you'll send the Florida Blue EOB to APL so we can complete the processing.
[AGENT][NEUTRAL] That's correct, and I can give you our claim number.
[CUSTOMER][NEUTRAL] Yes. And I can give you our number. Tell me claim number.
[AGENT][NEUTRAL] Our claim number is 351.
[CUSTOMER][NEUTRAL] Our claim number is 351.
[AGENT][NEUTRAL] 8482.
[CUSTOMER][NEUTRAL] OK, OK. Can we access UOB for disclaiming, uh, you told uh some website, uh, secured [PII]. In that website also you can see UOB for this claim.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] For this claim, yes, sir.
[CUSTOMER][NEUTRAL] For this claim, yes, sir. OK. APL. OK. At present, there is not showing any information about, uh, not showing any UOB information to you like a load and the paid amount like uh uh it's when paid and uh which payment which option to pay is not showing anything to you.
[AGENT][NEUTRAL] For the APL claim.
[AGENT][NEUTRAL] That's right, because we don't have the Florida Blue EOB that will be the EOB that will show us what was applied to the deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] That's right, because we don't have the Florida Blue EOB that will be the EOB that will show us what was applied to the deductible co-pay or coinsurance. OK.
[AGENT][NEUTRAL] That we need to process this secondary claim.
[CUSTOMER][NEUTRAL] That we need to process the secondary claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I, uh, we, I now we submit primary you will be to [PII].
[AGENT][NEUTRAL] Well, you'll need to submit the claim to Florida Blue.
[CUSTOMER][NEUTRAL] Yes. Well, you'll need to submit the claim to [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Once Florida Blue processes the claim, they'll send you an EOB.
[CUSTOMER][NEUTRAL] Once Florida Blue processes the claim, they'll send you an EOP. OK.
[AGENT][NEUTRAL] And then once you receive that Florida Blue EOB,
[CUSTOMER][NEUTRAL] And then once you receive that Florida Blue EOB.
[AGENT][NEUTRAL] Then you will need to send that to APL.
[CUSTOMER][NEUTRAL] Then you will need to send that to APL. OK.
[CUSTOMER][NEUTRAL] OK. Can you have the call reference number?
[AGENT][NEUTRAL] Call reference number is my name and today's date.
[CUSTOMER][NEUTRAL] reference number is my name and today's date.
[AGENT][NEUTRAL] And I spell my name, [PII]
[CUSTOMER][NEUTRAL] OK. Can you spell my name [PII], first initial last name [PII] OK.
[AGENT][NEUTRAL] CIA first initial last name [PII]
[AGENT][POSITIVE] And [PII], it was a pleasure to assist you with that claim status. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] And that's why a pleasure to assist you with that claim status. Is there anything else I can help you with? Uh, thank you. Not having any claim status. Thank you for asking me. Have a good day. Bye-bye.
[AGENT][POSITIVE] My pleasure. I hope you have a great day as well and thank you for calling APL.
[CUSTOMER][POSITIVE] I hope you have a great day as well and thank you for calling APS.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] The