AccountId: 011433970860
ContactId: bc17d91e-5f42-4d31-a5bc-8ec0d8e093d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 636789 ms
Total Talk Time (AGENT): 206580 ms
Total Talk Time (CUSTOMER): 184044 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/bc17d91e-5f42-4d31-a5bc-8ec0d8e093d3_20250307T14:28_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] Hey, [PII], it's [PII] calling from the provider office to know the claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I can help you with that and [PII], how many claims do you have to check status on today?
[CUSTOMER][NEUTRAL] Two claims.
[AGENT][NEUTRAL] For the same patient or different patients?
[CUSTOMER][NEUTRAL] Different patients.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. So [PII], you will use my name along with today's date as your call reference number for each claim that I check. Also any information that I provide for you on the claims will be a verification of benefits and not a guarantee of payment. And lastly, [PII], if we do have a claim on file and you need a copy of the explanation of benefits, you may print that by going to our portal.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Which is located at [PII].
[AGENT][NEUTRAL] And what is the first patient's policy number, please?
[CUSTOMER][NEUTRAL] The policy number is, just wait a second, I'll provide you.
[CUSTOMER][NEUTRAL] It's 02549553.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, I need for you to verify the name because that is not the name that we have on file.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Just wait a second.
[CUSTOMER][POSITIVE] It's [PII].
[AGENT][NEUTRAL] I'm sorry, what is the last name?
[CUSTOMER][NEUTRAL] The last name is [PII]. [PII].
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And the data service and total bill amount please.
[CUSTOMER][NEUTRAL] Date of service [PII] and total charge amount $21,248 even.
[AGENT][NEUTRAL] OK, did you say $21,248?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this claim was received on
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] This claim was received on [PII].
[CUSTOMER][NEUTRAL] I think I
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] Let's processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 355-0984.
[AGENT][NEUTRAL] And the reason for the denial states to please provide copies of the explanation of benefits from the primary insurance carriers.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] As for checking in our system, we have already sent you the primary EOP.
[AGENT][NEUTRAL] We do not have the primary EOB for this claim, for this data service for this member.
[CUSTOMER][NEUTRAL] Previously.
[CUSTOMER][NEUTRAL] OK. I'll send you once again. Can you just
[CUSTOMER][NEUTRAL] Crosscheck with the fax number is [PII].
[AGENT][NEUTRAL] I have checked. Yes, sir. OK.
[AGENT][NEGATIVE] That is the correct fax number and that fax was not received.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you just tell me your mailing address? I will send via mailing.
[AGENT][NEUTRAL] Yes, so what address do you show on file for the member for this policy?
[CUSTOMER][NEUTRAL] Yes, wait a second.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII] code [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][POSITIVE] Yes, sir, that is correct.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] I'll provide you with another payer ID.
[AGENT][NEUTRAL] What is the next patient policy number?
[CUSTOMER][NEUTRAL] Yes. Just wait a second.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Are you ready, [PII]?
[AGENT][NEUTRAL] I am. Yes, sir.
[CUSTOMER][NEUTRAL] It's 01070427.
[AGENT][NEUTRAL] I'm sorry. No, I don't know. What is that number you're giving me?
[CUSTOMER][NEUTRAL] Policy number.
[AGENT][NEUTRAL] Start over, please.
[CUSTOMER][NEGATIVE] Your voice is breaking.
[AGENT][NEUTRAL] What is the policy number?
[CUSTOMER][NEUTRAL] It's 01070427.
[AGENT][NEUTRAL] OK. I'm not understanding the first part of what you're saying, [PII].
[AGENT][NEUTRAL] What is the first? OK, 0.
[CUSTOMER][NEUTRAL] 0.
[CUSTOMER][NEUTRAL] 1070427.
[AGENT][NEUTRAL] One moment please.
[AGENT][NEUTRAL] 01070427. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And your patient's name and date of birth on this policy?
[CUSTOMER][NEUTRAL] The patient last name is [PII] and the first name is [PII]. And date of birth, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount please.
[CUSTOMER][NEUTRAL] Date of service is [PII] and total charge amount $46,688 even.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And the provider name on this claim, who is this, what is the facility for this claim?
[CUSTOMER][NEUTRAL] It's HCA Florida Kendal Hospital.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so this claim was received as well. The received date was [PII].
[AGENT][NEUTRAL] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 355-0927 and this one was also denied because we do need the primary insurance company's explanation of benefits, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In this claim, also, we have already sent you the primary EOP via fax multiple times.
[AGENT][NEUTRAL] OK, we have not received the information.
[CUSTOMER][NEUTRAL] We will send you via mail once again.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Did the same mailing address as the other claim that we just verified.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII].
[AGENT][POSITIVE] Oh, you're welcome. And is there anything else, [PII], that I can help you with today?
[CUSTOMER][POSITIVE] No, thank you so much. Your call reference number will be your name and today's date, right?
[AGENT][POSITIVE] OK. Well, you're very welcome.
[AGENT][NEUTRAL] My name is
[AGENT][POSITIVE] Yes, so that is correct.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Well, you're welcome and thank you again for calling APL and I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.