AccountId: 011433970860
ContactId: ae79b53e-948b-43c1-8e82-f1ab00b93529
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 388010 ms
Total Talk Time (AGENT): 182001 ms
Total Talk Time (CUSTOMER): 104668 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/ae79b53e-948b-43c1-8e82-f1ab00b93529_20250217T17:47_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check client status. Could you please spell out your name?
[AGENT][NEUTRAL] [PII] and yours?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And it's [PII] and last initial [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you, my initial is [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And [PII], what is a good call? Oh, you're welcome. What is a good callback number for you, please?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you and have how many claims did you say you have to check status on today?
[CUSTOMER][NEUTRAL] Uh, but 21 2nd, I'll check for that, uh, many claims.
[CUSTOMER][NEUTRAL] Only one claim.
[AGENT][NEUTRAL] OK, yes, ma'am. I can help you with claim status, [PII]. And what is the member's policy number?
[CUSTOMER][NEUTRAL] The member's ID is 02297146 M as in Mike, L as in Lima, 7.
[AGENT][POSITIVE] Thank you, one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth, please?
[CUSTOMER][NEUTRAL] The patient's name is?
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] Rate of service is now 25, 2024 and the total amount is $8,304 even.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, one moment, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is the name of the group that you're calling on behalf of?
[CUSTOMER][NEUTRAL] HSCA Florida West Side Hospital.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, [PII], and again to verify the, the amount, you said that that was the total bill amount was $8,304 even, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, there is no claim on file for her for this data service and total bill amount.
[CUSTOMER][NEUTRAL] OK. Can I get the payer ID to resubmit it?
[AGENT][NEUTRAL] Yes, the payer ID is 60801.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And you will also need to include a copy of her primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, can I get the mailing address?
[AGENT][NEUTRAL] Uh, yes, the claim's mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][POSITIVE] Thank you so much. May I know the policy effect and term date?
[AGENT][NEUTRAL] The effective date is [PII] and there is no term date. The policy is active.
[CUSTOMER][POSITIVE] Thank you so much for that info. Is there any group name?
[AGENT][NEUTRAL] There is the group name is Pan American Tool Corp.
[CUSTOMER][NEUTRAL] It's Pan American.
[AGENT][NEUTRAL] Tool Corp.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, may I know the group number?
[AGENT][NEUTRAL] 22108.
[CUSTOMER][NEUTRAL] Is there any plan type?
[AGENT][NEUTRAL] This is a supplemental policy. We are not a major medical insurance carrier.
[CUSTOMER][POSITIVE] Thank you so much for that info. Uh, could you please, uh, spell out the group name?
[AGENT][NEUTRAL] Yes, ma'am. And then one.
[AGENT][NEUTRAL] PAN.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Next word is American, [PII] [PII] [PII] [PII] Next word is [PII], next word [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And once we
[CUSTOMER][POSITIVE] Thank you so much for that info.
[AGENT][NEUTRAL] You're welcome, [PII], and I do need to give you one piece of information once we have processed the claim here at APL, we do have a portal in which you can check claim status and also have access to our explanation of benefits, and our portal that you would go to to get that is secured.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. May I know the time if I need to resubmit the claim?
[AGENT][NEGATIVE] There is no timely filing limit?
[CUSTOMER][POSITIVE] Thank you so much. Can I get the call reference number?
[AGENT][NEUTRAL] My name that I gave you along with today's date.
[CUSTOMER][POSITIVE] Thank you so much for your time and assistance. Have a great day.
[AGENT][POSITIVE] You're welcome, [PII]. I hope you have a great day too, [PII], and if that's all I can help you with, thank you again for calling APL.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Bye bye.