AccountId: 011433970860
ContactId: c8c3ee2c-68b3-4727-92c0-5e573c6fa2ef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 457890 ms
Total Talk Time (AGENT): 136732 ms
Total Talk Time (CUSTOMER): 121209 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/c8c3ee2c-68b3-4727-92c0-5e573c6fa2ef_20250206T20:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, this is [PII]. That's [PII], [PII] calling from provider office for the claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with the claim status. um, can you please give me your, your, um, sorry, your callback number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, let me get it to you. It's uh [PII] direct line.
[AGENT][NEUTRAL] Thank you, sir. What is the patient's name?
[CUSTOMER][NEUTRAL] OK. Patient name will be [PII].
[AGENT][NEUTRAL] OK, and what's the patient's date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And the patient's policy number, please?
[CUSTOMER][NEUTRAL] 01644805 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, and then what is the data service?
[CUSTOMER][NEUTRAL] It is for [PII].
[AGENT][NEUTRAL] And the charge amount please?
[CUSTOMER][NEUTRAL] For $732 even.
[AGENT][NEUTRAL] And then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] After the primary? OK, let me see. OK, actually, you are the primary insurance, right, for this member?
[AGENT][NEUTRAL] No, um, we're the secondary.
[CUSTOMER][NEUTRAL] OK. Actually, we have submitted the claim for Cigna and they denied like uh you are the primary insurance, so we have built this claim to you.
[AGENT][NEUTRAL] OK and then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] OK, facility will be Flamingo Anesthesia Associates.
[AGENT][NEUTRAL] OK, I'm gonna look up the claim for you real quick, [PII]. I'm gonna put you on hold and I'll be right back.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK. Sure, thank you.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Alright, this is [PII]. I did find the claim. The claim number is 350.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 1485.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] The claim was received on [PII].
[AGENT][NEUTRAL] And was processed
[AGENT][NEUTRAL] On the [PII].
[AGENT][NEUTRAL] And the claim was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, sir. Who's the primary insurance you know?
[AGENT][NEUTRAL] No, you just said Cigna.
[CUSTOMER][NEUTRAL] OK, so is the primary insurance?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] But uh even denying like uh they need the primary insurance from, I don't know like who's exactly here.
[AGENT][NEUTRAL] Right. We're the secondary insurance.
[CUSTOMER][NEUTRAL] But uh
[CUSTOMER][NEUTRAL] OK, do you have like uh information for the primary insurance?
[AGENT][NEUTRAL] No, I do not. I just know that you said Cigna.
[CUSTOMER][NEUTRAL] We don't have any information regarding the primary insurance for this member.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] Because we already have billed this claim for the signa and they are studying like missing in complete invalid primary insurance information. So again, we have built this and even you're denying like primary insurances.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Well, we need the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] Yeah, you just tell me your fax number.
[AGENT][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And what's your ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Please tell me like uh bill address.
[AGENT][NEUTRAL] Yes, the APL claims [PII] that's in [PII].
[CUSTOMER][NEUTRAL] 77, just repeat the ZIP code.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 73.
[CUSTOMER][NEUTRAL] OK, time limit to submit the current claim or uh yes, please submit a claim.
[AGENT][NEUTRAL] We don't have one.
[CUSTOMER][NEUTRAL] OK. What is timely filing number to submit a bill?
[AGENT][NEUTRAL] We don't have all the timely filing limit for an appeal is 180 days from the date the claim initially was processed and you'll also need to send a letter while you're appealing the claim.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And uh I need the call reference number now?
[AGENT][NEUTRAL] Yes, sir, you can use my name. It's [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Beautiful. Thank you so much. Yeah, that's it.
[AGENT][POSITIVE] You're welcome [PII]. You have a blessed rest of your day and thank you for calling APL.
[CUSTOMER][POSITIVE] Same to you. Bye. Have a great day.
[AGENT][NEUTRAL] You too bye bye.