AccountId: 011433970860
ContactId: db41b28d-54dd-41c0-b106-4566c2b6dd89
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 363299 ms
Total Talk Time (AGENT): 138415 ms
Total Talk Time (CUSTOMER): 127175 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/db41b28d-54dd-41c0-b106-4566c2b6dd89_20250127T13:07_UTC.wav
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[AGENT][NEUTRAL] Morning, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider office to check on a claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Uh yes, ma'am.
[AGENT][NEUTRAL] Yes, I can help you with that [PII] what is your callback number please?
[CUSTOMER][NEUTRAL] Yes, callback number [PII], direct line.
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am. One moment, please.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, ma'am. Our member policy number is 02372882 M as in Mike, L as in Lima 7.
[AGENT][NEUTRAL] OK, [PII], thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. You will use my name along with today's date as your call reference number, and if we do have the claim on file and you need a copy of the explanation of benefits, you may print that by going to our portal at [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So first off, if you could please verify your patient's name and date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yes. Uh-huh member's name is [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Thank you. The data service and total bill amount for her, please.
[CUSTOMER][NEUTRAL] D of service is [PII].
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] And build amount, 2000.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and total bill amount.
[CUSTOMER][NEUTRAL] And 7 $7,986 even.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEGATIVE] And also, uh, previously, they have denied, uh, they need the primary EOB. We submitted uh uh EOB multiple times.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Could you please check on that?
[AGENT][NEUTRAL] I will check this data service and I can tell you what we have received.
[AGENT][NEUTRAL] If we have received your explanation of benefits that we were in need of.
[CUSTOMER][POSITIVE] Mm thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the facility name provider name for this claim you're searching for?
[CUSTOMER][NEUTRAL] It's CA Florida, JFK Hospital.
[AGENT][NEUTRAL] OK, so ours
[CUSTOMER][NEUTRAL] Johnson S. Kennedy.
[AGENT][NEUTRAL] Uh-huh. Do you have the claim number for the original claim that we received were we denied it needing the explanation of benefits?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes. Yes, yes. 347-892-7.
[AGENT][NEUTRAL] OK, one moment, so yes ma'am, I see that that is still the only we have not received an explanation of benefits. How have you all been submitting that to us?
[CUSTOMER][NEUTRAL] OK, one moment, ma'am. Let me check on that. Actually, we send it to
[AGENT][NEUTRAL] Cause that is the only.
[AGENT][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] Mhm. Fax number is [PII].
[AGENT][NEGATIVE] That is not correct.
[AGENT][NEGATIVE] That is not the correct fax number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The last number is a 3 and not a 5. It's [PII].
[CUSTOMER][NEUTRAL] 7, OK.
[CUSTOMER][NEUTRAL] Yes, uh 2 [PII]. Uh, uh, that's, uh, the fax number we submitted.
[AGENT][NEUTRAL] Yes, she said 942 5.
[CUSTOMER][NEUTRAL] Uh, oh, OK. I'm sorry, ma'am, but we submitted to [PII]. Um, uh, may I know, we can submit this, uh, claim along with primary EOP so you can get the claim along with EUB. Is that OK?
[AGENT][NEUTRAL] Yes, that is fine. But as of now, we have only received the claim and not the primary explanation of benefits.
[CUSTOMER][NEUTRAL] OK, ma'am. And
[CUSTOMER][POSITIVE] Thank you, ma'am. What is the time we're filing?
[AGENT][NEGATIVE] There's no timely filing on there.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm referring to submit claim.
[CUSTOMER][NEUTRAL] That means uh EOB.
[AGENT][NEGATIVE] Uh yes, ma'am. Correct. I just said that there was no timely filing.
[CUSTOMER][NEUTRAL] No, that is fine. OK, thank you so much. Could you please spell your name for my documentation purpose, ma'am?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, thank you and thank you so much for your assistance, ma'am. Have a wonderful day.
[AGENT][POSITIVE] You're certainly very welcome, [PII] if that's all I can help you with, thank you again for calling APL and I hope you have a nice day also.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Bye bye.