AccountId: 011433970860
ContactId: d10e23b7-0c3c-4257-af25-e0ba478ed88a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 635320 ms
Total Talk Time (AGENT): 205163 ms
Total Talk Time (CUSTOMER): 161786 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/d10e23b7-0c3c-4257-af25-e0ba478ed88a_20250522T20:36_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from the provider office to check the claim status.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status. And how do you spell your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] OK. And you're calling from which facility for my notation?
[CUSTOMER][NEUTRAL] Sunrise Hospital.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, thank you. May I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02141739 ML 7.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure, member's first name spelled as [PII] Last name spelled as [PII] Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] So, the date of service is [PII] and the total charge is $8,853 even.
[AGENT][NEUTRAL] OK, thank you. That was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me see if I can find this claim. For future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] And let's see. OK, let me check this last submission. OK, one moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, I'm still waiting on the documents, OK? Alright.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] OK, so it looks like the last time we received the claim was on March, um.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII] and we process on [PII] and it looks like we did receive the explanation of benefits on this one, but the the explanation of benefits from the primary insurance did not list the amount applied towards the deductible co-payment and co-insurance. We are the secondary policy.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So primary U is required for this?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] How can we send the primary UB? Is there any fax number?
[AGENT][NEUTRAL] Yes, the fax number is [PII].
[CUSTOMER][NEUTRAL] Do we need to attach the UB zero form with the primary UB?
[AGENT][NEUTRAL] You don't have to. We already have that one. We received that one twice. We just need the primary EOB indicating the amount applied towards the deductible co-payment or co-insurance.
[CUSTOMER][POSITIVE] OK. Thank you so much for this information. I do have one more claim on file. Can you please help me with that one?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Is it gonna be a different member or the same member?
[CUSTOMER][NEUTRAL] Uh, different member?
[AGENT][NEUTRAL] Different number. OK, let me go ahead and make a note on this one before moving forward, OK? One moment.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] On the.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] P.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] P
[CUSTOMER][NEUTRAL] 02263082 M. Mike Lima number 7.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Member's first name is [PII] and the last name spelled as
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service is [PII] and the total charge is $10,337 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] No, OK.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I don't have a claim for that amount for $10,037 even.
[CUSTOMER][NEUTRAL] OK. So as I can check, the claim has been billed through PayPal.
[CUSTOMER][NEUTRAL] Sorry, electronic. And the claim was submitted on [PII]. So sorry, the claim was submitted on [PII]. So can you please help me with the electronic pay ID mailing address, timely filing so that we can resubmit the claim.
[AGENT][NEUTRAL] OK. Um, yes, um, this one needs to be either fax or mail. So I'm gonna give you the fax number and the mailing address. I can give you the payer ID, but it's only for your records, um, because this one needs to be attached to it, OK?
[AGENT][NEUTRAL] Um, so the fax number is [PII].
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[AGENT][NEUTRAL] The mailing address?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 248.
[AGENT][NEUTRAL] 950.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 95
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. After that?
[AGENT][NEUTRAL] Uh, and the zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] I time.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] We don't have time family limits.
[CUSTOMER][NEUTRAL] OK. And the
[CUSTOMER][NEUTRAL] Per ID?
[AGENT][NEUTRAL] Payer ID is 60801.
[CUSTOMER][POSITIVE] OK. Thank you so much for this information. So, can you please provide me the effective date of the patient?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Sure. Let me get that.
[AGENT][NEUTRAL] All right, let's see.
[AGENT][NEUTRAL] Effective date is [PII] and it terminated [PII].
[CUSTOMER][NEUTRAL] [PII] of terminated on?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for this information. Can you please provide me the reference number for today's call?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] So, can you please spell out your name?
[AGENT][NEUTRAL] Sure, that's [PII]. Last initial is [PII].
[CUSTOMER][POSITIVE] Thank you so much. Have a nice day.
[AGENT][POSITIVE] You as well thank you for calling APO bye bye.
[CUSTOMER][NEUTRAL] Bye
[AGENT][NEUTRAL] Mm.