AccountId: 011433970860
ContactId: f6297898-18c2-4b89-90ea-5f952d1653c1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1498750 ms
Total Talk Time (AGENT): 455556 ms
Total Talk Time (CUSTOMER): 542844 ms
Interruptions: 3
Overall Sentiment: AGENT=0, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/f6297898-18c2-4b89-90ea-5f952d1653c1_20250512T17:58_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] Uh, yes, [PII], this is [PII] with Lakeland Regional Medical Center, and I'm calling in regards to a patient's claim.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim status. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][POSITIVE] Definitely help you with the claim
[CUSTOMER][NEUTRAL] And [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and the member's policy number?
[CUSTOMER][NEUTRAL] Um, let me see what we have.
[CUSTOMER][NEUTRAL] I have 00018.
[CUSTOMER][NEUTRAL] 19429 ML 8
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] $5,142.05.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Lakeland Regional Medical Center.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Alright, so I'm showing received the claim on August, I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is
[CUSTOMER][NEUTRAL] You have a claim number?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's what I was asking for the client number. Go ahead.
[AGENT][NEUTRAL] The claim number is 359-415-9.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, because we're needing a um diagnosis code, so it can be received on a bill, um, doctor's note, um, um, admission or discharge papers.
[CUSTOMER][NEUTRAL] 00 hold on.
[CUSTOMER][NEUTRAL] You, what are you needing?
[AGENT][NEUTRAL] Diagnosis.
[CUSTOMER][NEUTRAL] On the claim you don't have the the diagnosis codes it should be on the on the on the UB.
[AGENT][NEUTRAL] Let me see what was received. Hold on one moment.
[AGENT][NEUTRAL] Checking.
[AGENT][NEUTRAL] Alright, do you mind if I place you on just a brief hold while I locate the documents that were sent in?
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Oh, that's not it.
[AGENT][NEUTRAL] What?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Am I tripping?
[AGENT][NEUTRAL] So we're the real what?
[AGENT][NEUTRAL] So how do you know what documents came in if the
[AGENT][NEGATIVE] You know what, I don't have time for that. I'm about to do it just like this.
[AGENT][NEUTRAL] We're gonna go to clean. Oh no, not that. I need this.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] What is the male number?
[AGENT][NEUTRAL] 423-25363.
[AGENT][NEGATIVE] Wasted all that time. What does it, when did it say it came in?
[AGENT][NEGATIVE] I never picked that.
[AGENT][NEUTRAL] Because it was that, OK, go ahead, girl.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Remittance, no diagnosis. No.
[AGENT][NEUTRAL] Charges.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, thank you so much for holding. I apologize for that wait. So we, for this claim, two copies of a remittance was sent over, but there's no code on here. It's charges.
[CUSTOMER][NEUTRAL] It is it a red and white claim uh.
[AGENT][NEUTRAL] Um, I don't see colors, but on the top it just says, um, hold on, let me go back to it.
[AGENT][NEUTRAL] National standard intimidary remittance advice, like it's not an explanation of benefits.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, no, that's the, um, is it from Blue Cross and Blue Shield?
[AGENT][NEUTRAL] Um.
[AGENT][NEGATIVE] I really don't even see.
[AGENT][NEUTRAL] I see Lakeland. It says health options to the right, Lakeland Regional to the left, and then the insured's name.
[AGENT][NEUTRAL] Um, it doesn't list the insurance company's name.
[CUSTOMER][NEUTRAL] So, um, you don't see anything that says health options.
[AGENT][NEUTRAL] Uh, to the, to the right. Mhm.
[CUSTOMER][NEUTRAL] On you to to the right.
[CUSTOMER][NEUTRAL] Yeah, that's, that's, that's, uh, Blue Cross the Blue Shield. That is the primary EOB and it should also have on there a patient responsibility for $500 where it a copay.
[AGENT][NEUTRAL] Mhm. I mean, I see the charges, but we're asking for the code this year.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, so they sent you this and so you don't have the, the one that have like a bunch of like boxes on it.
[AGENT][NEUTRAL] Taxes.
[CUSTOMER][NEUTRAL] And they're numbered.
[AGENT][NEUTRAL] Mhm. It's like, this looks like a, like a ledger, I guess I could say it looks like.
[CUSTOMER][NEUTRAL] I know talking about the one that says the a national standard on it that one, yeah, OK, I know what you're talking about that's OK, so that's the primary EOB, um, OK, so you don't have the, um, I'm not sure if y'all coordinate with the patient's primary, but, um, they sent you over that because, um, just showing you what was left to the patient responsibility, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's all we've received.
[CUSTOMER][NEUTRAL] But um I can, can this be faxed to you?
[AGENT][NEUTRAL] The explanation of benefits from primary?
[CUSTOMER][NEUTRAL] Explanation
[CUSTOMER][NEUTRAL] No, you already have that. That's what you're looking at because you see the $500 copay.
[AGENT][NEGATIVE] This is not an explanation of benefits.
[AGENT][NEGATIVE] The explanation of this is not an explanation of benefits, but um that's why we can't use it.
[CUSTOMER][NEUTRAL] The the, the, the one, the one with the national standard and you see where it says um health options that that is our um EOB that we receive from Blue Cross and Blue Shield where how the primary insurance paid $1,659.66 with a patient responsibility of $500.
[CUSTOMER][NEUTRAL] That's the primary EOB that we submitted over to you, but what I guess I'm thinking that you're asking for is the UB, not the EOB, but the UB, the one you're looking at now is the primary EOB explanation of benefits, but what you're wanting is the um.
[CUSTOMER][NEUTRAL] The UB
[CUSTOMER][NEUTRAL] Where um it has the, the charges on it.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And the um.
[AGENT][NEUTRAL] procedure code.
[CUSTOMER][NEUTRAL] And the and the yeah and the diagnosis cold so I'm I'm thinking you must be didn't get that.
[AGENT][NEUTRAL] Well.
[AGENT][NEUTRAL] Yeah, we did it. It's just two copies of the, the, the national.
[CUSTOMER][NEUTRAL] Um, and let me see.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEGATIVE] It looked like it was returned, it was returned back to us we had um let me see how we submitted it to you, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because I do see uh like the, the stuff that they sent to you it was returned back so um is there a um.
[CUSTOMER][NEGATIVE] I don't know what address they sent it to. I just noticed it was returned.
[CUSTOMER][NEUTRAL] Um, let me see. Oh, they sent it to [PII], what is that?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][POSITIVE] Oh, that's correct. Mhm.
[CUSTOMER][NEUTRAL] It it was sent back to us.
[AGENT][NEGATIVE] It was sent back
[AGENT][NEUTRAL] Was it sent to [PII] first and then?
[CUSTOMER][POSITIVE] Yep I got it back.
[AGENT][NEUTRAL] Because that's the only time they send it, because we did used to have the address in [PII] and it was forwarded, but now people are saying that the mail has been sent back and we give them the [PII] address. So I don't know, maybe that's what happened.
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, because I just.
[CUSTOMER][NEUTRAL] Yeah, I think they are saying for time.
[AGENT][NEGATIVE] Oh, it expired.
[CUSTOMER][NEUTRAL] Wait, but they, yeah, and they um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And they returned it back to us.
[AGENT][NEUTRAL] OK, so it sounds.
[CUSTOMER][NEUTRAL] So do you is there a, do you have a fax I can fax it over.
[AGENT][NEUTRAL] Mhm. Let me know when you're ready.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, um, let's see, go ahead.
[AGENT][NEUTRAL] So it's 877.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK, 942 3.
[AGENT][NEUTRAL] And that's attention
[CUSTOMER][NEUTRAL] Alright, and I'm making attention.
[AGENT][NEUTRAL] APL claims department.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] ACL
[AGENT][NEUTRAL] No, APL like Paul.
[CUSTOMER][NEUTRAL] OAP
[CUSTOMER][NEUTRAL] APL.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] APL claims department.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's what I'll say.
[CUSTOMER][NEUTRAL] OK, I'll fax that. I'll fax it over to you and do y'all need me to refax this premier EOB?
[CUSTOMER][NEUTRAL] As well
[AGENT][NEUTRAL] Uh, no, you don't have to. As long as the UB has the um code, you're fine.
[CUSTOMER][NEUTRAL] Or are you good with that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, you say your name is [PII]?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, is there a call reference number, [PII]?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and the first initials of my last name is [PII].
[CUSTOMER][NEUTRAL] OK, I'm just make sure I don't have any more claims out here for her, oh, which I do.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] I do have more claims for her. um I'm not sure if all these are having the same issue, um, because I have her a data service of [PII].
[CUSTOMER][NEUTRAL] With the billed amount of $5,142.05.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there any other
[CUSTOMER][NEUTRAL] I do have a claim number for that one if you need the claim number.
[AGENT][NEUTRAL] Does it end in 0608 or 4378?
[CUSTOMER][NEUTRAL] Yeah 0608.
[AGENT][NEUTRAL] Here it is
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Well, this one
[AGENT][NEUTRAL] Well, what's, OK, so what question did you have? Because this one was paid.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, when was it paid?
[AGENT][NEUTRAL] Um, you said what or when?
[CUSTOMER][NEUTRAL] When
[AGENT][NEUTRAL] It was OK, let me get the date for you. Hold on one second.
[AGENT][NEUTRAL] [PII]. 0, so you may not have received it yet.
[CUSTOMER][NEUTRAL] OK, alright, so do you have like uh payment information, check information, EFT?
[AGENT][NEUTRAL] Let me get the check for you.
[AGENT][NEUTRAL] Mhm. It was a single check. Hold on, I'm getting a check number for you.
[AGENT][NEUTRAL] And the amount of $500.
[CUSTOMER][NEUTRAL] They pay $500 OK.
[AGENT][NEUTRAL] Um, check number is 204.
[AGENT][NEUTRAL] 31
[CUSTOMER][NEUTRAL] 04
[AGENT][NEUTRAL] 36
[CUSTOMER][NEUTRAL] And they they have a check date.
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so we just haven't received that one yet.
[CUSTOMER][NEUTRAL] And how about her data service of 21 through [PII]?
[AGENT][NEUTRAL] 21 and [PII] and what was the total bill?
[CUSTOMER][NEUTRAL] And the total bill amount is $5,142.05.
[CUSTOMER][NEUTRAL] On that one.
[CUSTOMER][NEUTRAL] And I have a claim number ending in 2817.
[AGENT][NEUTRAL] 2817. OK, here we go.
[AGENT][NEUTRAL] So this one, well,
[AGENT][NEUTRAL] Does it need to have that range? Because this one only shows [PII], but that is the claim number that you gave.
[AGENT][NEUTRAL] Is that OK?
[CUSTOMER][NEUTRAL] Uh, hold on, is the, is the amount the same?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I think so, but let me double check. Yes, it's $5,142.05 and we pay $500 to this one also.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah but uh check number and check date.
[AGENT][NEUTRAL] Hold on 1 2nd.
[AGENT][NEUTRAL] So single check, check number 204.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 323 5.
[AGENT][NEUTRAL] Let me see when that was sent out.
[AGENT][NEUTRAL] OK, this one was also um sent out on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's check number 204.
[AGENT][NEUTRAL] 3235.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I have one.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] This date is [PII].
[CUSTOMER][NEUTRAL] Uh, no, no, it's not, it is [PII].
[AGENT][NEUTRAL] Please
[CUSTOMER][NEUTRAL] 37 on this one, yeah, let me see if I have a claim number for this one as well.
[CUSTOMER][NEUTRAL] Uh, this one is ending in 7365.
[AGENT][NEUTRAL] 7365 you said?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And date of service is [PII]?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Uh, hold on.
[AGENT][NEUTRAL] 736.
[AGENT][NEUTRAL] What's the full claim number because for this one?
[CUSTOMER][NEUTRAL] I have 877-365.
[AGENT][NEUTRAL] Wait, 877-365. That's our fax number.
[CUSTOMER][NEUTRAL] Uh, yeah, sure, it's part of the thing, uh.
[AGENT][NEUTRAL] If it, now we do have one here from [PII] and it's the same amount as the other two, but it's a different, um, it's claim number 359-4159.
[CUSTOMER][NEUTRAL] It sure is.
[CUSTOMER][NEUTRAL] OK, I got, uh, what is that client number then?
[AGENT][NEUTRAL] Um, this one is 359-415-9.
[CUSTOMER][NEUTRAL] 4159.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, yeah, that's the same, same amount.
[AGENT][NEUTRAL] 4159, let me get that for you. Now this one, what, let me see what happened with this one.
[AGENT][NEUTRAL] OK, this one is denied requesting the diagnosis, so the you be for this one too.
[CUSTOMER][NEUTRAL] OK, so for for the 3.
[CUSTOMER][NEUTRAL] What is this?
[AGENT][NEUTRAL] 37.
[AGENT][NEUTRAL] Oh wait, this is the same time as the first one.
[CUSTOMER][NEUTRAL] Oh OK all right.
[AGENT][NEUTRAL] I was like, wait a minute, that looks OK, yes, that's what it is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, uh, was it OK, so what do we do here?
[CUSTOMER][NEUTRAL] I'm trying to wait, did I get out of that I gotten confused here.
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what do we have the 37, did you give me that one already?
[AGENT][NEUTRAL] 37 is the first one and the one that we just looked at.
[CUSTOMER][NEUTRAL] 7
[AGENT][NEUTRAL] We had 37 twice.
[CUSTOMER][NEUTRAL] OK, OK, so alright, that's uh 3.
[CUSTOMER][NEUTRAL] 7 and then we went this one and this one OK.
[CUSTOMER][NEUTRAL] Um, about, I don't know if you have this one you have 3:22.
[AGENT][NEUTRAL] 322.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Am I'm looking for the same amount for that one, or this is different?
[CUSTOMER][NEUTRAL] And this is a different amount. This one is $14,911.53.
[AGENT][NEUTRAL] OK, so let's see what came in on the [PII].
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] One
[AGENT][NEUTRAL] 24
[AGENT][NEUTRAL] Oh, I got it on the 1st try. Hold on one second, here it is.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] He's surprised.
[AGENT][NEUTRAL] Sorry.
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] OK, so this one we received on [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's claim number 3585324.
[AGENT][NEUTRAL] Looks like we just finished processing it today because it just has like a generic [PII] date on it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But we are paying out $1000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And since it just finished today, there's no like check number or anything populated, but tonight at [PII], all of that will populate. So if you wanted to call back to get that tomorrow, it should be up here for us to see.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so if you're paying out $1000 is there any patient responsibility?
[AGENT][NEUTRAL] Um, so we don't determine patient responsibility because we're not the major medical.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK, because it looks like um.
[CUSTOMER][NEUTRAL] I guess there was 4000.
[CUSTOMER][NEUTRAL] That's it uh
[AGENT][NEUTRAL] 4012.
[CUSTOMER][NEUTRAL] 4,002 yeah $12 was patient responsibility and of that you all um you all are paying $1000 right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so I guess that'd be.
[CUSTOMER][NEUTRAL] Remaining patient once it finished processing.
[CUSTOMER][POSITIVE] And let me see, I got one more here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well I I got two more, but I don't know. Well, no, I have one more and this one is for our data service for [PII].
[CUSTOMER][NEUTRAL] For $5,142.05.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You said [PII], right?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For that one, I'm not showing a a claim on file for that date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Alright, I'll just give it a little more time.
[CUSTOMER][NEUTRAL] Oh yeah I see what happened now the primary got to process it first, OK.
[CUSTOMER][POSITIVE] Alright, I'll make sure I get that other one over to you.
[CUSTOMER][POSITIVE] [PII] and I thank you.
[AGENT][POSITIVE] You're very welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No ma'am that's it.
[AGENT][POSITIVE] Alright, well thank you so much for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Mhm.