AccountId: 011433970860
ContactId: c60cf4dc-79a6-4894-a4ee-36a71fb68c8f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 655359 ms
Total Talk Time (AGENT): 210844 ms
Total Talk Time (CUSTOMER): 210292 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/c60cf4dc-79a6-4894-a4ee-36a71fb68c8f_20250317T13:38_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]. This is [PII] calling with facility to check on the claims.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status, [PII], and um may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII] direct line.
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I have a total of 3 claims.
[AGENT][NEUTRAL] OK, may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, just a second.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The member policy number is 01994155ML7.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth, [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'd like me to check on?
[CUSTOMER][NEUTRAL] Mm, yeah, just a second.
[CUSTOMER][NEUTRAL] The date of service is going to be
[CUSTOMER][NEUTRAL] Mm July, sorry, [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] $10,708.
[AGENT][NEUTRAL] Thank you for that. And may I have the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, sure. The provider office is HCA Florida West Side Hospital.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] So I'm showing the um claim was received on [PII].
[CUSTOMER][NEUTRAL] 6216
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim number is 349.
[AGENT][NEUTRAL] 3352.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Oh, OK. Let me check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so as I can see, uh, the primary was sent through the fax on [PII].
[CUSTOMER][NEUTRAL] Just 4 days before.
[AGENT][NEUTRAL] OK, let me see if this is.
[CUSTOMER][NEUTRAL] Sorry, uh, the [PII], yeah, [PII].
[AGENT][NEUTRAL] OK, wait. So you're saying that you sent in the explanation benefits after this claim was processed?
[CUSTOMER][NEUTRAL] Yes, so the claim got denied. So we have sent this recently because we have called and we have uh got that uh Medicare you be was needed. So we have sent this on [PII] through the fax number [PII].
[AGENT][NEUTRAL] OK, so that has not been received. Um, the reason I asked is because we only have this one claim here for this data service. Had it been received, we would see that one also, but this policy is not second to, did you say Medicare or UnitedHealthcare?
[CUSTOMER][NEUTRAL] United Healthcare Primary, primary Insurance UB. Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, I just want to make sure. So no, we haven't received the explanation of benefits, but you can still send that in. The fax number that you gave was correct. Um, we just have not received it, but you can send it in and we'll be more than happy to process once we receive.
[CUSTOMER][NEUTRAL] So does it take some time to you because we have sent uh um I can see uh with the fax number on [PII].
[AGENT][NEUTRAL] Right, but it's a fact. So sometimes they get lost in transmission or do you have the confirmation someone that it was sent successfully in the time?
[CUSTOMER][NEUTRAL] Mm, yeah, it just stated that it was sent to American public like and the fax number mentioned.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] So usually there's a confirmation that comes with that once it's sent successfully, but even with the confirmation, you can't really guarantee a fax. So as I've stated, the policy is still active. There's no timely filing. I do apologize that we haven't received it, but you do, you can still send it in for processing.
[CUSTOMER][NEUTRAL] Mm, OK, fine.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] So we can send once again, right to the same fax number.
[AGENT][NEUTRAL] Yes, you can also send it electronically or mail it.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Need to and the fax number is correct, right?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] OK. May I know your name?
[AGENT][NEUTRAL] Sure, my name is [PII] [PII].
[CUSTOMER][NEUTRAL] And may I know the reference number for this call?
[AGENT][NEUTRAL] So the reference number for the entire call will be my name and today's date. The first initial to my last name is L like Larry, my first name is [PII]
[CUSTOMER][NEUTRAL] In today's date, OK.
[CUSTOMER][NEUTRAL] Just a second. Let me close this.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, can you help me with the next one? Can we start?
[AGENT][POSITIVE] Yes, I'm ready for you. I'm waiting for you whenever you're ready.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm, yeah. Do you want member ID?
[AGENT][NEUTRAL] Yes, I'll need the policy number.
[CUSTOMER][NEUTRAL] 02419373
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mm yes. The member name is [PII] Last name [PII] Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the um data service and the total bill for the member?
[CUSTOMER][NEUTRAL] I'm checking, just a second.
[CUSTOMER][NEUTRAL] Uh, yeah, and the date of service for this is [PII]. Total charge $12,614.
[AGENT][NEUTRAL] Alright, and that was [PII]?
[AGENT][NEUTRAL] And the um total bill is $12,614.
[CUSTOMER][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Alright, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yes, I see Florida Dal Hospital.
[AGENT][NEUTRAL] OK, so we've received this twice. Um, the first claim that we received.
[AGENT][NEUTRAL] Well, [PII].
[AGENT][NEUTRAL] The claim number was 351.
[AGENT][NEUTRAL] 0411.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting an explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] I received it again.
[CUSTOMER][NEUTRAL] Denied on September.
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, fine.
[CUSTOMER][NEUTRAL] T
[CUSTOMER][NEUTRAL] [PII], received and denied on [PII]. Let me check if we have the claim you'll be on file. Just a second.
[CUSTOMER][NEUTRAL] Mm, OK, fine. We have the Medicare Primary U be on file and we can send to the same fax number, right? [PII].
[AGENT][NEUTRAL] You said what insurance? I'm sorry?
[CUSTOMER][NEUTRAL] The primary insurance. Let me check. It's uh A V M E D HMO, Florida.
[AGENT][NEUTRAL] OK. Yes, OK. I just want to make sure you have the correct primary. Yes, once we receive the explanation of benefits, we'll go ahead and um continue processing for you.
[CUSTOMER][NEUTRAL] OK. So do you need claim form also or just the prim EOB?
[AGENT][NEUTRAL] Um, that's up to you. They come in both ways. Um, sometimes they have the claim form on it, sometimes it's just the explanation of benefits. It's your preference.
[CUSTOMER][NEUTRAL] Yeah, uh, so we, uh, if you are required just prime UV then we can send only that, right? So you are needing just pri UV, right? So we'll proceed with that only, correct?
[AGENT][NEUTRAL] That's fine. You can, yes, you can send it either way with the claim form or without, whatever you prefer.
[CUSTOMER][POSITIVE] OK, fine. We'll send on the primary. Thank you so much. That's all I have for the day. Thank you so much. Bye for now. Take care.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. Bye-bye.