AccountId: 011433970860
ContactId: a44497fa-d1f2-4025-a858-3ea72833086a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 554890 ms
Total Talk Time (AGENT): 175006 ms
Total Talk Time (CUSTOMER): 166774 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/a44497fa-d1f2-4025-a858-3ea72833086a_20250109T16:42_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the.
[AGENT][NEUTRAL] I'm sorry, the phone's going in and I couldn't hear you. Can you repeat that, please?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office to check on a claim status.
[AGENT][NEUTRAL] OK, well, I'll be more than happy to help you with the claim status Ivy. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Two claims.
[AGENT][NEUTRAL] Thank you for that. And may I have um a good contact number in case we're disconnected and the policy number for the first member?
[CUSTOMER][NEUTRAL] Sure. The callback number is [PII]. And the policy number is 02363839.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] The member's name is [PII]. Just one moment, let me double check here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes. 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. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Sure. The date of service on the claim is August. Uh just a moment.
[CUSTOMER][NEUTRAL] It is [PII] and the total charge is $23,398 even.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And are you calling in reference to the original claim that was um submitted or the two that were submitted after?
[CUSTOMER][NEUTRAL] The original claim.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] HCA Florida West Side Hospital.
[AGENT][NEUTRAL] Thank you. So I'm showing the uh the claim, sorry, was received on [PII].
[AGENT][NEUTRAL] That claim number is 348.
[AGENT][NEUTRAL] 5205.
[AGENT][NEUTRAL] And on [PII]?
[AGENT][NEUTRAL] Excuse me, the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK. We have sent the UB on [PII]. Can you please kindly check whether the Us received?
[AGENT][NEGATIVE] So we haven't received anything as of [PII]. However, there were two claims that were received for this, um, but they were both denied as duplicates as we still need the explanation of benefits.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. And there is no, you'll be attached to the claim form also, right?
[AGENT][NEUTRAL] Um, let me double check this last one. Hold on one second so I can see what was sent.
[AGENT][NEGATIVE] Yeah, so what, what's being sent over is just one page. It's the claim form, um, there's no explanation of benefits attached.
[AGENT][NEGATIVE] I do see on like inbox 80 it says you'll be attached, but there there's only one page, there's nothing else here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can you please provide me your fax number?
[AGENT][NEUTRAL] Mhm. So it's [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 9423. OK. And it was attention to claims rate?
[AGENT][NEUTRAL] Yes, attention APL claims department.
[CUSTOMER][NEUTRAL] APL.
[CUSTOMER][NEUTRAL] APL claims department. Uh, do you have any timely final limit for this one to submit the ZOB?
[AGENT][NEUTRAL] No, um, this is additional information, so um, once we receive it, we'll go ahead and continue processing.
[CUSTOMER][POSITIVE] OK, thank you so much. Let me go ahead and get the next one here. Thank you so much for this information on this claim.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] The next one here.
[CUSTOMER][NEUTRAL] OK. For this one, the facility's name is Memorial Savannah.
[AGENT][NEUTRAL] Is it the same member?
[CUSTOMER][NEUTRAL] A different member.
[AGENT][NEUTRAL] OK, what's their policy number?
[CUSTOMER][NEUTRAL] So the
[CUSTOMER][NEUTRAL] Their policy number is 01677458.
[AGENT][NEUTRAL] Here we go. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII]'s date of birth, [PII].
[AGENT][NEUTRAL] Thank you for that. And again, all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total charge is $10,825 even.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] I already, I already gave the provider. So I'm showing that this claim was red. Oh, hold on one moment, it didn't slip yet.
[CUSTOMER][NEUTRAL] For this one, I have the claim information as received and denied on [PII] and [PII]. So for this one, we have sent the explanation of benefits on [PII]. So, I just want to know whether the bill is received in your end.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I'm waiting for the documents to come up that were received. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so yes, the explanation of benefits has been received and it's currently in processing.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] And it was received on the same day of [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And the claim is in reprocessing rate?
[AGENT][NEUTRAL] Yes, as of [PII]. Mhm.
[CUSTOMER][NEUTRAL] May I know the turnaround time for the reprocessing?
[AGENT][NEUTRAL] Um, it's 7 to 10 business days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can you please provide me the call reference number for the entire call?
[AGENT][NEUTRAL] Sure, um there's no call reference number, but you can use my name. So that's [PII], first initial to my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] OK, thank you so much. Have a good day. Take care. Bye for now.
[AGENT][POSITIVE] You also and thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] Bye bye.