AccountId: 011433970860
ContactId: d18635a7-f8b0-4767-84fd-dda7582a0b9b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1115880 ms
Total Talk Time (AGENT): 319505 ms
Total Talk Time (CUSTOMER): 272212 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/2025/06/09/d18635a7-f8b0-4767-84fd-dda7582a0b9b_20250609T17:34_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] Hello, this is [PII] calling from the Worldla group on a recorded line. I'm calling to have an update and just to confirm something pretty quickly if you guys have completed payments on some providers for a client's account.
[AGENT][NEUTRAL] So you want to go over claim status?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, I think I have.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A claim number, give me 1 2nd.
[CUSTOMER][NEUTRAL] Yeah, I do have a claim number.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] OK, so your name is [PII], and you're calling from the group you said?
[CUSTOMER][NEUTRAL] I'm calling from the Wardla Group.
[AGENT][NEUTRAL] OK, so you're calling from the provider's office?
[CUSTOMER][NEUTRAL] We are the client's attorney.
[AGENT][NEUTRAL] Are you calling from the employer or you're calling from the provider?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Which one, the employer or the provider? I'm asking because that determines how I look up the claim.
[CUSTOMER][NEUTRAL] We are the client's attorney.
[AGENT][NEUTRAL] Oh, you're the attorney, OK.
[AGENT][NEUTRAL] And you're needing to go over claim status?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] Um, I only have the claim number. Would that work?
[AGENT][POSITIVE] OK, yes, the claim number is fine.
[CUSTOMER][NEUTRAL] So it is 359-873-3.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, and can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, that's gonna be uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, so for this claim,
[AGENT][NEUTRAL] So you needing like the day we received it and processed it and the the the denial reason?
[CUSTOMER][NEUTRAL] I would like basically would like to confirm if you guys completed payments um to Jackson.
[CUSTOMER][NEUTRAL] Uh, like to 3 providers. I just wanted to confirm if you guys, uh, complete payments to them.
[AGENT][NEUTRAL] If we complete payments to them.
[AGENT][NEUTRAL] I don't understand your question. Are you just trying to see if someone was to send a claim to us if we would pay it out?
[CUSTOMER][NEUTRAL] Exactly. So did you complete payments to Jackson?
[AGENT][NEUTRAL] This claim was not, there is no payment for this claim. This claim was denied requesting additional information.
[CUSTOMER][NEGATIVE] Why it was denied because no additional information was provided.
[AGENT][NEUTRAL] OK, so this particular claim number that you gave me was denied.
[AGENT][NEUTRAL] Requesting the explanation of benefits from primary insurance.
[CUSTOMER][MIXED] OK, but that information was provided like 2 months ago.
[AGENT][NEUTRAL] OK, so I can look and see what came over. Hold on one moment.
[CUSTOMER][NEUTRAL] You don't have it yet?
[AGENT][NEUTRAL] Are you saying after the claim was denied, you then sent over the explanation of benefits from primary or are you saying that it was sent with the claim originally?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It was sent after that, yeah, initially you guys mentioned that you didn't have the claim, so we contacted you, provided you the correct information, and you guys did complete payments, but we have 3 providers that did not receive payments and I would like to know the reason why.
[AGENT][NEUTRAL] All I can do is give you, if you have the claims, I can give you the denial reason for it. I can look, let me find the data service for this and see. Hold on one second.
[AGENT][NEUTRAL] Is this the same?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] Yeah, sure. Thank you.
[AGENT][NEUTRAL] Alright, hold on one moment you're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] Alright, hold on.
[AGENT][NEUTRAL] It's these 3.
[AGENT][NEUTRAL] LG.
[AGENT][NEUTRAL] To
[AGENT][NEUTRAL] 360 1926.
[AGENT][NEUTRAL] OK, and then.
[AGENT][NEUTRAL] 3604553.
[AGENT][NEUTRAL] Duke. So the original was this.
[AGENT][NEUTRAL] It's a different amount.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Oh Lord.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] That was one and then it was paid out of that one. OK, that's not the same thing. So what's this?
[AGENT][NEUTRAL] It was just this by itself.
[AGENT][NEUTRAL] So if I go to the 2nd 1.
[AGENT][NEUTRAL] 926.
[AGENT][NEUTRAL] And do, oops.
[AGENT][NEUTRAL] 926 and do this, it should be the 10,000.
[AGENT][NEUTRAL] OK, I got it.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Sierra.
[CUSTOMER][NEUTRAL] Yeah, I'm here.
[AGENT][NEUTRAL] Alright, thank you so much for holding. I apologize for that wait. So after the original was denied as a dupe on [PII] I'm sorry, was denied requesting the additional information. On [PII], we received it and we paid out. Um, did you need that claim number?
[CUSTOMER][NEUTRAL] Yes, if you could provide it to me, give me one second.
[CUSTOMER][NEUTRAL] Let me open my notes. Give me one second.
[CUSTOMER][NEUTRAL] OK, I'm ready for the claim number.
[AGENT][NEUTRAL] It's 360-1926.
[CUSTOMER][NEUTRAL] 360-1926
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], we paid out to the provider a total of $60,0026.40.
[CUSTOMER][NEUTRAL] OK, to which providers?
[AGENT][NEUTRAL] This is the Jackson Memorial Hospital.
[CUSTOMER][NEUTRAL] Jackson Memorial. Um, I also have other two that I need to confirm, for example, University of Miami Health System.
[AGENT][NEUTRAL] What's the data we can't go by provider. What's the go ahead.
[CUSTOMER][NEUTRAL] Or, let me ask you this.
[CUSTOMER][NEUTRAL] Yeah, let me, let me ask you this. Do you have like a summary of payments?
[AGENT][NEUTRAL] No, we have a record of the claims process, so it doesn't go by provider.
[CUSTOMER][NEUTRAL] That you can send me.
[AGENT][NEUTRAL] It goes by the data service. So, what's the data do you have the data service for the providers you're trying to see if they were paid? Because I can't just type in like the provider name and something pops up. I would need a date that correlates with the claim or a claim number.
[CUSTOMER][NEUTRAL] Um, yes. So for one of them, it's 527-2024.
[AGENT][NEUTRAL] What's the total bill, because all of these that we're working on is 527 of 24.
[CUSTOMER][NEUTRAL] 845.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] 845.
[AGENT][NEUTRAL] Let me see what this one is, hold on one moment.
[AGENT][NEUTRAL] And what's the name of the provider?
[CUSTOMER][NEUTRAL] That's gonna be um.
[CUSTOMER][NEUTRAL] Miami-Dade.
[CUSTOMER][NEUTRAL] Fire rescue.
[AGENT][NEUTRAL] OK, now this is something different.
[AGENT][NEUTRAL] Let me see if this one is different.
[AGENT][NEUTRAL] Yeah, we don't have anything for that date of service for [PII] for $845. Is there another total bill that can be?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEGATIVE] Oh, no, that's I have and it's uh I was told that they haven't received any payments. I have another one if you don't mind.
[CUSTOMER][NEUTRAL] Checking it for me. Um, so this one went, uh, went to collection, so I'm not sure if I should provide you the name of the collections agency or?
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The the actual name of the provider.
[AGENT][NEUTRAL] Neither. What's the date of service?
[CUSTOMER][NEUTRAL] Let me get that for you. Give me 1 2nd.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] Um, that was [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was the total bill for that one?
[CUSTOMER][NEUTRAL] Total bill for that one will be
[CUSTOMER][NEUTRAL] 8 898.
[AGENT][NEUTRAL] $398?
[CUSTOMER][NEUTRAL] 898.
[AGENT][NEUTRAL] 890, OK.
[AGENT][NEUTRAL] Wait, now that was on the other day. Hold on. OK, hold on one second.
[AGENT][NEUTRAL] 520.
[AGENT][NEUTRAL] 124.
[AGENT][NEUTRAL] 20.
[AGENT][NEUTRAL] OK, um,
[AGENT][NEUTRAL] So I'm not showing one with
[AGENT][NEUTRAL] Mm, not for the [PII]. Hold on one second.
[AGENT][NEUTRAL] So there is a claim for [PII], but it's way more than the 898.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the last two claims we didn't have anything on file for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Are, are you guys able to send me something in writing? It doesn't matter if it's only the date of service.
[AGENT][NEUTRAL] I mean, I can see the explanation of benefits.
[AGENT][NEUTRAL] Send you something in writing for the claim that we have on file or the two that we didn't?
[CUSTOMER][POSITIVE] Yeah, that will work.
[CUSTOMER][NEUTRAL] You can send me any documentation that will be fine because we actually don't have anything that's why I'm I'm calling to confirm the payments that were made, so um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, basically, if you could send me any information, if you have any summary of payments, if it's showing only the date of service, it doesn't matter. You can, you can send it to me, um, if you can send it to me via fax or email, email would be great, but if it's possible.
[AGENT][NEUTRAL] OK, um, sure, I'll send the one that we went over that we paid out to because that's the only one we have documentation for. Um, what's the name of the um attorney's office you're calling from so I can put it in the notes as well?
[CUSTOMER][NEUTRAL] So it's gonna be the, the word W A R T.
[CUSTOMER][NEUTRAL] The word law.
[AGENT][NEUTRAL] So [PII]
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, and what's a good fax number for you?
[CUSTOMER][NEUTRAL] So the fax number it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so it's [PII] attention [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, so I'll go ahead and send that explanation of benefits over to you now. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] That will be all. Thank you very much.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too, bye.