AccountId: 011433970860
ContactId: c108ed84-05fc-4c46-a29d-6eb1aaa0ec22
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1007049 ms
Total Talk Time (AGENT): 200916 ms
Total Talk Time (CUSTOMER): 340737 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/c108ed84-05fc-4c46-a29d-6eb1aaa0ec22_20250220T17:36_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, uh, this is [PII] calling you from provider's office checking on a claim status. How are you doing today?
[AGENT][POSITIVE] I'm good. How about you, Mr. [PII]?
[CUSTOMER][POSITIVE] Great, thanks for asking.
[AGENT][POSITIVE] You're welcome. And sure, I can assist you with claim status, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, that is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I as in igloo, C as in cat, I as in igloo, 163666189724.
[AGENT][NEUTRAL] OK, our, our policy numbers doesn't have any letters in the beginning. Uh, do you have the copy of the card?
[CUSTOMER][NEUTRAL] Just a moment. I do have the insurance ID card. Just a moment. Uh let me go over there and check it for you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Insurance ID card.
[CUSTOMER][NEUTRAL] And uh.
[CUSTOMER][NEUTRAL] Um, it seems like, uh, some misconception, some discrepancy, uh, what about, uh, we go do and, uh, a name search?
[CUSTOMER][NEUTRAL] Maybe the member ID would be incorrect.
[AGENT][NEUTRAL] Um, yeah, I can do a name search. What's the spelling of the last name?
[CUSTOMER][NEUTRAL] It's um [PII].
[AGENT][NEUTRAL] OK, and what's the spelling of the first name?
[CUSTOMER][NEUTRAL] Um, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Let me see if I can find this number with the name, OK? One moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] That would be nice.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, uh, do you have an address for Ms. [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do have.
[CUSTOMER][NEUTRAL] And that is going to be [PII], sorry, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I think I found her. What's her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right. OK, yeah.
[AGENT][NEUTRAL] And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] That was.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. And the amount was $909 even.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] 309. OK, here it is um.
[AGENT][NEUTRAL] Let me pull this one moment.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, so it looks like we received this claim on [PII] and processed [PII], and we're still needing the primary explanation of benefits to continue the processing of this claim. We have not received this as of today.
[CUSTOMER][NEUTRAL] OK, upon checking here, I'm seeing that there is a previous call not mentioned on this account and stating it has been paid. Just a moment. Let me get you more information about the, uh, thing that's for with uh process and um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's stating the paid amount was shown in the claim number 3518482. Is that the same claim number that you have on file?
[AGENT][NEUTRAL] No, uh uh. No, that's not ours. That's too long. Um, it looks like Florida Blue is the primary insurance and that may be the claim from Florida Blue, but we have not received that EOB.
[CUSTOMER][NEUTRAL] OK, then, uh,
[CUSTOMER][NEUTRAL] Oh yeah. Here is the thing. When I checked the insurance ID card, I see a Florida Blue um ID card, but it has been listed as it is secondary under the same member ID and here it is billed to America Public Life under the same.
[CUSTOMER][NEUTRAL] And a different member ID.
[CUSTOMER][NEUTRAL] Oh my [PII]. I'm really sorry. Actually, I gave you an incorrect member ID. The correct member ID was 02473288. Uh, is that the correct member ID for this number? OK. So the claim has been denied stating, OK. So the claim has been denied stating America Public Life was uh.
[AGENT][NEUTRAL] Mhm, yeah.
[AGENT][POSITIVE] Yes, that's the one I found.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Secondary for this member, right?
[AGENT][NEUTRAL] Correct. And, and we need the primary EOB to continue the processing of this claim.
[CUSTOMER][NEUTRAL] OK, got it. But
[CUSTOMER][POSITIVE] Let me grab some more information from your side and I just want you to repeat your name by spelling if that is possible, then it is great.
[AGENT][NEUTRAL] Mhm. Sure. My name is [PII]'s [PII]. Last initial [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May you said the claim was received on [PII]?
[CUSTOMER][NEUTRAL] Right?
[AGENT][NEUTRAL] I'm sorry, what's?
[AGENT][NEUTRAL] The date that we process the claim?
[CUSTOMER][NEUTRAL] You have
[CUSTOMER][NEUTRAL] No, the claim was received date.
[AGENT][NEUTRAL] Oh, received date. OK. The received date was, and let me go back again, [PII], process [PII], needing the primary EOB.
[CUSTOMER][NEUTRAL] OK. Can I know what is the claim number?
[AGENT][NEUTRAL] Claim number is 351-8482.
[CUSTOMER][NEUTRAL] 351-848-2.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 341, right?
[AGENT][NEUTRAL] It's 351-848-23518482.
[CUSTOMER][NEUTRAL] Yeah, I know that
[CUSTOMER][NEUTRAL] OK, here's the thing, 351-848-2 under the same claim number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Paid amount not shown claim number. Your page not showing to me. I access this claim of. OK, fine, and I'm really sorry. Some it is some kind of aged accountant so I'm getting confused a lot. I'm really sorry for that. My apologies.
[AGENT][NEUTRAL] It's OK. It's OK.
[CUSTOMER][NEUTRAL] So on.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] stating requesting.
[CUSTOMER][NEUTRAL] Do
[CUSTOMER][NEUTRAL] Requesting.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I primary.
[CUSTOMER][NEUTRAL] Better off but.
[CUSTOMER][NEUTRAL] OK, as per you, the American Public Life or APL is secondary for the member, right?
[AGENT][POSITIVE] We're secondary, correct.
[CUSTOMER][NEUTRAL] 14 and birth.
[CUSTOMER][NEUTRAL] And Blue Cross Blue Shield was primary for the member, right?
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] May I know when was the last time the patient has been updated the COB?
[AGENT][NEUTRAL] I'm not sure. We're not the primary.
[CUSTOMER][NEUTRAL] OK, so the number has never updated Prime, uh COB2.
[CUSTOMER][NEUTRAL] Your insurance?
[AGENT][NEUTRAL] They don't have to update COB to our insurance. They have to update COB to their primary insurance, which is Florida Blue.
[AGENT][NEUTRAL] We are always secondary. We don't have any primary insurance or major medical insurance.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Here is the thing, though the claim was requesting primary OB, I do not have uh any OB on file, uh.
[AGENT][NEUTRAL] You don't have an EOB from uh Florida Blue?
[CUSTOMER][NEUTRAL] That stating the claim.
[CUSTOMER][NEUTRAL] Mm, no, I haven't received any OB.
[AGENT][NEUTRAL] OK, then you need to contact Florida Blue to get an EOB from them and then we need a copy of that EOB to process our claim with APL.
[AGENT][NEUTRAL] So we need the primary EOB.
[CUSTOMER][NEUTRAL] Um, no.
[CUSTOMER][NEUTRAL] Uh, uh, I'm not talking about that. I get it, but in order to build the claim to, uh, the primary, we should receive a denial from the secondary.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I haven't received a denial from APL. I haven't received an EOB from APL that request stating that the claim has been denied as requesting primary OB.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What what's the
[AGENT][NEUTRAL] What is the fax number, Mr. [PII]?
[CUSTOMER][POSITIVE] That would be nice.
[CUSTOMER][NEUTRAL] So the fax number is going to be [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] That's right. Awesome.
[AGENT][NEUTRAL] OK. Do you mind holding for me while I send this out to you right now?
[CUSTOMER][NEUTRAL] Attention, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you mind holding for me? I'm gonna put you on a hold so I can go ahead and send this fax over, OK?
[CUSTOMER][NEUTRAL] Oh, now it's just got.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for Mr. [PII]. OK, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] Can you please help me with the car reference number?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date if you will.
[CUSTOMER][POSITIVE] That would be nice.
[CUSTOMER][POSITIVE] Have a nice day bye for now. Take care.
[AGENT][POSITIVE] Thank you for calling APO. Have a good day bye bye.