AccountId: 011433970860
ContactId: cd584d5e-3563-4c3b-91d6-91caec48e9d0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 563640 ms
Total Talk Time (AGENT): 142824 ms
Total Talk Time (CUSTOMER): 138763 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/cd584d5e-3563-4c3b-91d6-91caec48e9d0_20250102T18:40_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from the provider office to check the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status, No. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Only just one claim?
[AGENT][NEUTRAL] Alrighty, may I have the member's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure. It is 19658.
[AGENT][NEUTRAL] That's all all of it, is that the group number or the policy number?
[CUSTOMER][NEUTRAL] So you can check it over here in our system it is mentioned 19658 policy number.
[AGENT][NEUTRAL] What's the member's first and last name?
[CUSTOMER][NEUTRAL] Sure. It is
[CUSTOMER][NEUTRAL] I can spell it out [PII] and last name spelled as [PII] And date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for that. So yes, that's actually the group number. Let me go ahead and give you the policy number.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The policy number is 2,501,680.
[AGENT][NEUTRAL] 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?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Sure, the date of services.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] $29,769 even.
[AGENT][NEUTRAL] Thank you. And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yes, it is HCF Florida Northwest Hospital.
[AGENT][NEUTRAL] Thank you. So I'm showing you received the claim on [PII].
[AGENT][NEUTRAL] That claim number is 349.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 862 4.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And on, hold on, I forgot to get that date.
[AGENT][NEUTRAL] On [PII], the claim was denied.
[AGENT][NEUTRAL] Requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] means you're stating that we need to submit the explanation of benefit means EOB of the primary.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Primary, you'll be right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] So we need to submit primary you be with the
[CUSTOMER][NEUTRAL] Corrected claim
[AGENT][NEUTRAL] Um, you don't have to submit a correct the claim. You can just submit the explanation of benefits and we'll continue processing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, can I get the
[CUSTOMER][NEUTRAL] Uh, means through which we can submit it primary will be through fax or uh means address, meeting address.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] You can fax it, you can mail it, or you can send it electronically. Um, which one do you prefer? Do you, would you like all three?
[CUSTOMER][NEUTRAL] You can provide fax number.
[AGENT][NEUTRAL] Alright, so that's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] OK. Just I want to confirm it is [PII], yes, yes.
[AGENT][NEUTRAL] And that's gonna be a
[AGENT][NEUTRAL] That will be attention APL claims department.
[CUSTOMER][NEUTRAL] OK, yes. So, I just want to confirm the fax number. It is [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh I want to confirm the
[CUSTOMER][NEUTRAL] Claim number it is 349-8624.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. Just a moment.
[CUSTOMER][NEUTRAL] Can I get the the primary UB?
[AGENT][NEUTRAL] Are you asking who the primary insurance is?
[CUSTOMER][POSITIVE] Yes, primary insurance, yes, yes, very sorry.
[AGENT][NEUTRAL] Oh, it's OK. I'm showing that it's United Healthcare.
[CUSTOMER][NEUTRAL] And we
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can you, can you do check once because we have sent the primary UB with the UV 0 form.
[CUSTOMER][NEUTRAL] Yes, we have submitted it.
[AGENT][NEUTRAL] Um, I can
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hold on one moment, let me take a look.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the documents are populating. Hold on one moment.
[AGENT][NEGATIVE] Oh, now I opened up multiple times. Hold on one second.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[AGENT][NEGATIVE] OK, so we've only, we only received one page and this is the claim form. There is no other pages with this claim form. At the bottom, I do see in box 80 for the remarks, it does say EOB attached, but there's no EOB, it was just one page.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. You
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Can you provide me the reference number for this? And thank you so much for your assistance.
[AGENT][NEUTRAL] You're welcome. So there's no call reference number, but you can use my name, which is [PII].
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] All right, thanks for calling APL and happy New Year.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Bye bye.