AccountId: 011433970860
ContactId: b1dcc8b8-583e-475f-8f69-6a6620be3438
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287649 ms
Total Talk Time (AGENT): 104450 ms
Total Talk Time (CUSTOMER): 67720 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/b1dcc8b8-583e-475f-8f69-6a6620be3438_20250606T12:57_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, [PII]. My name is [PII] calling from facility for the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, I have only one claim.
[AGENT][NEUTRAL] OK, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02419388 M as in Mike L as in Lima number 7.
[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] Uh, patient name is [PII] and 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 and the total bills for the claim?
[CUSTOMER][NEUTRAL] Uh, [PII] and the bill amount is $72,0099 even.
[CUSTOMER][NEUTRAL] And it's a date in [PII].
[AGENT][NEUTRAL] So it's not [PII]?
[AGENT][NEUTRAL] To [PII]? OK.
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's the first one.
[AGENT][NEUTRAL] Here it is. Alright, I just located the claim. I'm waiting for it to come up now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Uh, yes, the HCF Florida Mercy Hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We received the claim 3 times. Were you wanting the original claims or the duplicates?
[CUSTOMER][NEUTRAL] Uh, no, original claim.
[AGENT][NEUTRAL] Alright, so you received the original claim on [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The claim number is 351.
[AGENT][NEUTRAL] 9968.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And on [PII], the claim was denied, requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Uh, what is the denied date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. So it's denied for it primary OB.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] So, previously, we send the primary office. So can you check if you received it or not?
[AGENT][NEGATIVE] We did receive 2 claims after, but there was no explanation of benefits attached, which is why it was denied as a duplicate both times.
[CUSTOMER][NEUTRAL] OK. What is your fax number?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And what is the timely filing for submitting uh primary UB?
[AGENT][NEUTRAL] There's no timely filing limit for additional information. Once we receive it, we'll go ahead and continue processing.
[CUSTOMER][NEUTRAL] OK. Call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date, and again that's [PII].
[CUSTOMER][POSITIVE] Thank you for that information and have a great day.
[AGENT][POSITIVE] You also, was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, no, that's it.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye bye.