AccountId: 011433970860
ContactId: e5a6d9c3-9d21-4589-81cf-ceba15d985e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 709650 ms
Total Talk Time (AGENT): 190546 ms
Total Talk Time (CUSTOMER): 165314 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/e5a6d9c3-9d21-4589-81cf-ceba15d985e4_20250514T16:23_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from provider offices.
[AGENT][NEUTRAL] OK, I can help you with claim status, [PII]. May I please get your callback number, sir, just in case the call is disconnected.
[CUSTOMER][NEUTRAL] The callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] The patient
[CUSTOMER][NEUTRAL] Policy number is 000928.
[CUSTOMER][NEUTRAL] 76,900.
[CUSTOMER][NEUTRAL] And the patient's name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is on.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look up that policy.
[AGENT][NEUTRAL] OK, I'm not showing that is one of our policy numbers.
[AGENT][NEUTRAL] Do you see another number, uh, inpatient cert number, outpatient cert number, or?
[AGENT][NEUTRAL] One that begins with a 01 or 02.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][POSITIVE] Yes, sir. Take your time.
[CUSTOMER][NEUTRAL] No, I don't have any other policy number.
[CUSTOMER][NEUTRAL] Is this Tans America, right?
[AGENT][NEUTRAL] Do you have the member's social?
[AGENT][NEUTRAL] No, this is American Public Life.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Uh, can you check with the patient's social, social number is [PII]?
[AGENT][NEUTRAL] OK, let
[AGENT][NEUTRAL] Let me look that up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm checking now.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, um, let me see.
[AGENT][NEUTRAL] What is the date of service of the claim?
[CUSTOMER][NEUTRAL] The rate of services on
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yeah, it's correct.
[AGENT][NEUTRAL] OK, so for [PII], I do not see any active policies for her. Um, the last policy she had.
[AGENT][NEUTRAL] Um, terminated on [PII].
[CUSTOMER][NEUTRAL] But it's not that uh Trans America, right? Because I do have the payer name as Trans America. You said that American Public Life.
[AGENT][NEUTRAL] Right, we're not Transamerica.
[CUSTOMER][NEUTRAL] Yeah, OK. And uh
[CUSTOMER][NEUTRAL] You said the, the policy was done on [PII], right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Now she may have an active policy with Transamerica.
[CUSTOMER][NEUTRAL] Yeah, OK. And uh
[AGENT][NEUTRAL] But she does not have an active policy with American public life.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Can you verify the another claim?
[AGENT][NEUTRAL] Can I what, sir?
[CUSTOMER][NEUTRAL] Can you, can you check another claim status?
[AGENT][NEUTRAL] Another claim status?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For a different member?
[CUSTOMER][NEUTRAL] Yeah, it's for different number.
[AGENT][NEUTRAL] OK, and what is the member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] The policy number is 025.
[CUSTOMER][NEUTRAL] 792-229.
[CUSTOMER][NEUTRAL] Is this your policy?
[AGENT][NEUTRAL] And the member's name and date of birth?
[CUSTOMER][NEUTRAL] The member's name as
[CUSTOMER][NEUTRAL] [PII] and the date of birth is on [PII].
[AGENT][NEUTRAL] OK, let me pull that one in and see if we can find something.
[AGENT][NEUTRAL] OK, and then what is [PII]'s date of service and charge amount?
[CUSTOMER][NEUTRAL] The rate of services on [PII] with the bill amount is $9,751 20%.
[AGENT][NEUTRAL] OK, and then what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] It was $500 even.
[AGENT][NEUTRAL] OK, and the name of the facility you're calling from, [PII]?
[CUSTOMER][NEUTRAL] Uh, it's for HA Florida Woodmont Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look up this claim and I'll be right back sir.
[CUSTOMER][NEUTRAL] Yeah, OK. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII].
[AGENT][NEUTRAL] So looking at this claim, the claim num.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Number is 35.
[AGENT][NEUTRAL] 69,000 and the claim has been denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Yeah. And may I know whether, when it was received?
[AGENT][NEUTRAL] Yes sir, let me look that up.
[AGENT][NEUTRAL] We received the claim on [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] Uh, it was received on [PII], right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And it was processed on?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, OK. And it was made of primary, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah, we have already submitted the primary to the fax.
[CUSTOMER][NEUTRAL] Oh, just a moment.
[AGENT][NEUTRAL] OK, uh, what did you send that?
[CUSTOMER][NEUTRAL] It was sent on [PII]. So the fax number is [PII].
[AGENT][POSITIVE] Yes, that's the correct.
[AGENT][NEGATIVE] Fax number, but we have not received the EOB.
[CUSTOMER][NEUTRAL] And uh yeah, OK. Uh.
[CUSTOMER][NEUTRAL] And uh yeah, we will send the primary again to the fax number.
[AGENT][POSITIVE] Yes, sir, or you can even send it to our payer ID number. I can give that to you also.
[CUSTOMER][NEUTRAL] No, we will send the claim, uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Primary back again to the fax number.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And to the same fax number, right?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Yeah, OK, we'll send that again. Is there any time limit to send that? Time, time limit.
[AGENT][NEUTRAL] No, sir.
[AGENT][NEGATIVE] No, we do not have a timely filing limit.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] And uh yeah, that's it. Can I have the call offenses for this call?
[AGENT][NEUTRAL] Yes, sir. You can use my name, [PII]
[AGENT][NEUTRAL] And today's date.
[AGENT][NEUTRAL] Is that everything I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] Yeah, OK, OK.
[CUSTOMER][NEUTRAL] Uh, yeah. Yeah I already back.
[AGENT][POSITIVE] OK, well, I hope you have a wonderful day and thank you for calling APL sir.
[CUSTOMER][POSITIVE] Yeah, you too. Have a good day. Bye.
[AGENT][NEUTRAL] Bye bye.