AccountId: 011433970860
ContactId: e6b1d722-9f84-4e47-b215-81b09041a7a8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 392899 ms
Total Talk Time (AGENT): 126351 ms
Total Talk Time (CUSTOMER): 120877 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/e6b1d722-9f84-4e47-b215-81b09041a7a8_20250414T20:23_UTC.wav
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[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Call.
[CUSTOMER][NEUTRAL] Yes, can you hear me?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes. Hi, this is [PII] from provider's office to check the claim status.
[AGENT][POSITIVE] I can. Good afternoon. Thank you.
[AGENT][NEUTRAL] OK, you said your name is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, [PII], and you're wanting to check claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Number please, [PII].
[CUSTOMER][NEUTRAL] Can you hear me clearly?
[AGENT][NEUTRAL] I'm sorry, your voice cut out. No, I wasn't, no, ma'am, I could not hear the last part of what you said clearly.
[CUSTOMER][NEUTRAL] [PII] with my extension.
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] Only one claim.
[AGENT][NEUTRAL] OK. Yes, ma'am. I can help you. What is the member's policy number?
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] That's our electronic payer ID number.
[CUSTOMER][NEUTRAL] OK. So, I don't have the policy number. Could you please check with the patient.
[AGENT][NEUTRAL] That's not the policy number.
[CUSTOMER][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] I can't search, no, ma'am, I can't search my date of birth.
[CUSTOMER][NEUTRAL] That I got it. Wait, let me check. Uh, yes, yes, yes, I have.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Wait, wait. Let me provide you the policy number. 02363836. Is that right?
[AGENT][NEUTRAL] One moment, please.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for him?
[CUSTOMER][NEUTRAL] Uh, uh, it's number [PII], and the data also, sorry, uh, and the total bill amount is 1 minute $35,956 even.
[AGENT][NEUTRAL] And you said date of start is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] And the name of the facility?
[CUSTOMER][NEUTRAL] Uh, I'd say Florida Mercy Hospital.
[AGENT][NEUTRAL] OK, so this claim was received. The received date was [PII].
[AGENT][NEUTRAL] It was processed and denied [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the reason for the denial is.
[AGENT][NEUTRAL] That we are in need of the primary insurance company's Action of benefits.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It states, please provide copies of your explanation of.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. As for checking here, we already sent the primary EOP on [PII] to the fax number.
[CUSTOMER][NEUTRAL] OK. Let me provide you.
[CUSTOMER][NEUTRAL] Uh sorry, uh, to the mailing address [PII].
[AGENT][NEUTRAL] [PII]. And what day was that mailed?
[CUSTOMER][NEUTRAL] It's sent on [PII].
[AGENT][NEUTRAL] [PII], 4 days ago.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] OK, we have not received that at this time. Yes, ma'am, we've not received that at this time.
[CUSTOMER][NEUTRAL] Sorry? Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] One minute.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. Will I allow some time to process. When should I again call back for the status?
[AGENT][NEUTRAL] It typically takes about 10 business days for us to receive the claim.
[AGENT][NEUTRAL] Information via mail and then it would have to be there's an additional 7 to 10 business days for review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me call you in the next week. Can I get the call reference number?
[AGENT][NEUTRAL] The call reference number would be my name in today's date, and if you need a copy of this explanation of benefits, you may print that also, [PII], by going to our portal, which is located at [PII].
[CUSTOMER][POSITIVE] OK, got it. Thank you.
[AGENT][POSITIVE] You're welcome. And can I help you with anything else today?
[CUSTOMER][POSITIVE] Nothing else. Thank you.
[AGENT][POSITIVE] OK, well thank you