AccountId: 011433970860
ContactId: 01c5f0a9-bd27-4367-acea-0d05219f6aef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1170859 ms
Total Talk Time (AGENT): 327659 ms
Total Talk Time (CUSTOMER): 498676 ms
Interruptions: 7
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/01c5f0a9-bd27-4367-acea-0d05219f6aef_20250220T16:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling HR. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, this is [PII]. I'm calling from H HCA Florida Mercy Hospital, and I'm, uh, checking on the status of a claim.
[CUSTOMER][NEUTRAL] Trying to figure out where where this should go.
[AGENT][NEUTRAL] OK, I can help you with your claim.
[CUSTOMER][NEUTRAL] So, uh, let me give you the information and and then we can start, we can start, um, analyzing what what's going on, OK?
[AGENT][NEUTRAL] Yes, [PII]. OK, first, can I get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Not a problem.
[CUSTOMER][NEUTRAL] My callback number is [PII].
[AGENT][NEUTRAL] OK, and can you give me the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Name is.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. So let's say [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] His date of birth is [PII], 0 sorry, go ahead.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, you go ahead [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] 95 and the policy number, sir?
[CUSTOMER][NEUTRAL] 024788887.
[AGENT][NEUTRAL] OK. Let me look up that policy real quick.
[AGENT][NEUTRAL] You said that policy was 02478887?
[CUSTOMER][NEUTRAL] Yeah, that's what I'm looking at um in the system let me double check.
[AGENT][NEUTRAL] Yes, sir, because it's missing numbers.
[CUSTOMER][NEUTRAL] Alright, not the first time that this happened. Uh, let, let me, let me see here, um, some other pile of documents here. What, what else I got, um.
[CUSTOMER][NEUTRAL] Policy number 202478977 from APL.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] That's what I got.
[AGENT][NEUTRAL] OK, do you have insured's social security number and I could pull it in that way.
[CUSTOMER][NEUTRAL] Oh let me see if I got that.
[CUSTOMER][NEUTRAL] Nope, [PII], not on there.
[AGENT][NEUTRAL] Oh goodness. OK, what about a claim number?
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] Claim number
[CUSTOMER][NEUTRAL] Claim number 349-9045.
[AGENT][NEUTRAL] OK, let me see if I can find this claim, which may give me his policy number.
[CUSTOMER][NEUTRAL] Oh here I got another 3541502. That's what's with with APL. What did I give you the last time?
[CUSTOMER][NEGATIVE] Yeah, that's just no.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Well, it's different here let me give you the one that I'm seeing with APL.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] 3541502.
[AGENT][NEUTRAL] OK, let me give you the patient's policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 247-887-777.
[CUSTOMER][NEUTRAL] 247.
[CUSTOMER][NEUTRAL] 4877.
[AGENT][NEUTRAL] No, 247-887-777.
[CUSTOMER][NEUTRAL] 887-72478877.
[CUSTOMER][NEUTRAL] And and what was the claim number I gave you so I can correct it here on the on the on the in the system as well.
[AGENT][NEUTRAL] Well, you, you gave me to um.
[AGENT][NEUTRAL] The first one you gave me 3.
[CUSTOMER][NEUTRAL] The the last one, the one that pertains to [PII].
[AGENT][NEUTRAL] 3541502.
[CUSTOMER][NEUTRAL] Let me check that.
[AGENT][NEUTRAL] And is that the claim number you're calling about today?
[CUSTOMER][NEUTRAL] Because I'm, I'm, I'm
[CUSTOMER][NEUTRAL] Yeah, that's, I mean, did you have the other one as well?
[AGENT][NEUTRAL] Yeah, it was under his name.
[AGENT][NEUTRAL] But let me make sure that it's for your facility.
[CUSTOMER][NEUTRAL] OK, so you did have both of them.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Because.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Sometimes the information inside the system does not jive with.
[CUSTOMER][NEUTRAL] The information
[CUSTOMER][NEUTRAL] On the cards, OK.
[AGENT][NEUTRAL] I can pull up both claims and give you the remarks for them, um.
[CUSTOMER][NEUTRAL] Yeah, could you do that and pass me the claim numbers, both of them once again and then, uh, give me the remarks and then hopefully I can figure out what's going on here.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK, claim number 3541502.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Was paid.
[CUSTOMER][NEUTRAL] 354 I'm sorry, let me repeat that 354-0502?
[AGENT][NEUTRAL] Yes, sir. Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me look up.
[CUSTOMER][NEUTRAL] Get paid.
[AGENT][NEUTRAL] Yes, sir. I'm pulling up the check now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] was paid to HCA Florida Mercy Hospital.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] In the amount of $1,585.49 and the check is still outstanding.
[CUSTOMER][NEUTRAL] OK, so it.
[CUSTOMER][NEGATIVE] It has not been cashed.
[AGENT][NEGATIVE] Right, it has not been cashed.
[CUSTOMER][NEUTRAL] OK, that's interesting. Now, uh, and what was the other claim?
[AGENT][NEUTRAL] The other claim you gave me was 349-9045.
[AGENT][NEUTRAL] That claim has not been paid. It has a remark. Hold just a second, I'm about to sneeze.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the remark is.
[AGENT][NEUTRAL] OK, so it says we have received the primary explanation of benefits that was submitted with your claim. However, the explanation of benefits received does not list the amounts applied to the deductible copay or coinsurance. Please submit a more detailed explanation of benefits that shows these amounts for further consideration of the claim.
[CUSTOMER][NEUTRAL] OK, so, uh, it was, it was the not paid because the received POB wait.
[CUSTOMER][NEUTRAL] Could you repeat that again please what you just said? I was typing, I typed slowly. I apologize.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That's OK. The explanation of benefits received does not list the amounts applied to the deductible.
[AGENT][NEUTRAL] Co-pay or co-insurance?
[AGENT][NEUTRAL] So we need an EOB that has the amounts that were applied to the deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes, I, I, I apologize. Give me, uh, one moment here while I review my notes and try to, try to understand what, what, what went on because I got these really weird notes from a team in [PII] and I don't understand what.
[AGENT][POSITIVE] That's OK. Take your time.
[AGENT][NEUTRAL] Yes, that's fine.
[CUSTOMER][NEUTRAL] What it means.
[CUSTOMER][NEUTRAL] So I'm trying to put put together what what they tried to mean here if, if anything at all.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] So this policy, just if this helps you any, this policy only covers deductible, co-pay or co-insurance in a covered facility.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] It's a gap insurance. So in order for us to pay, we have to see where a deductible co-pay or co-insurance was paid by the primary first.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] The policy only covers the deductible, co-pay and co-insurance.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is that what you're saying?
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you need the.
[CUSTOMER][NEUTRAL] The POB in order to get.
[CUSTOMER][NEUTRAL] OK, so basically you, you need, you need the uh primary EOB.
[AGENT][NEUTRAL] Yes, that shows, right, we got the primary EOB, but it does not show that it paid for deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] And with that you're fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Well [PII], I don't know what to do with that. Let, let me look at my, let me look at, uh, what, what kind of forms I got here.
[CUSTOMER][NEUTRAL] Can you see the primary EOB?
[AGENT][NEUTRAL] No, I can't see it. I, no, I can only, um, see how the claim was processed.
[CUSTOMER][NEUTRAL] Do you have any information at all?
[CUSTOMER][NEUTRAL] OK. OK. Yeah, all right, hold on.
[CUSTOMER][NEUTRAL] OK, I got the POV here from Florida Mercy Hospital sent.
[CUSTOMER][NEUTRAL] To you all, a correspondence to American public life.
[CUSTOMER][NEUTRAL] Receive permanent explanation benefits submitted with your claim. However, explanation benefit received does not list the amounts applied to the deductible. Oh, that's exactly what you told me.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'm looking at that form.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I have one from Cigna here.
[CUSTOMER][POSITIVE] Which is processed as primary and I see that it is uh thanks for your patience while I while I mentally go over this. I just have to do it with you here so.
[AGENT][POSITIVE] Yes, that's fine. Sometimes it helps to have somebody there to help you walk through it, so I have no problem at all.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Yeah, yeah, because
[CUSTOMER][NEUTRAL] Alright, I, I, I make something weird and you'll be like, wait a minute, that's, that's not right. OK, I'm looking at the primary EOB from.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] From Cigna.
[CUSTOMER][NEUTRAL] Health and Life Company.
[CUSTOMER][NEUTRAL] And it's listing.
[CUSTOMER][NEUTRAL] It it seems to me like it's listing everything.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, I don't, alright, I'm gonna have to like look it over here. Let me see if there's a scenario that this fits into.
[CUSTOMER][NEUTRAL] That'll help me, you're missing the primary OB.
[CUSTOMER][NEUTRAL] And it has.
[CUSTOMER][NEUTRAL] I'm gonna put you on hold one sec, right? So you don't hear me like mumble through this. All right. OK, thank you.
[AGENT][NEUTRAL] Yes sir.
[AGENT][POSITIVE] OK. You're welcome.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello, I'm here.
[CUSTOMER][NEUTRAL] OK, I'm looking at the primary EOB. I just had like a colleague help me look it over with me and, and everything's on here, so, um, if you can't see it, I guess I'm just gonna resend the primary EOB over and uh hopefully that'll clear things up. OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir. Yes, sir.
[CUSTOMER][NEUTRAL] Now, um
[CUSTOMER][NEUTRAL] OK, let me, I'm downloading that right now.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I mean those type of things are so weird. I, I, this is what I think what should have happened, but it just seems so strange that I don't, um.
[CUSTOMER][NEUTRAL] I started to question myself going.
[AGENT][NEUTRAL] Yes, sir. I understand.
[CUSTOMER][NEUTRAL] If you have it, it should work, you know, right now, could you, I, you give me, um.
[CUSTOMER][NEUTRAL] I'm gonna need a fax number. Is that OK? Can I fax it to you?
[AGENT][POSITIVE] Yes you can the fact.
[CUSTOMER][NEUTRAL] Or do you need it mailed?
[AGENT][NEUTRAL] Um, the fax number is [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 942 3.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Is there an address as well just so I can have that as a backup?
[AGENT][NEUTRAL] Yes, sir. Uh, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII] City, [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII] one second. [PII].
[AGENT][NEUTRAL] Sorry, I forgot you said go slow.
[CUSTOMER][NEUTRAL] Ok uh.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] City, [PII].
[CUSTOMER][NEUTRAL] Which is OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And the fax, I mean the fax, the zip.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Let me make sure I got all the information here from you that I need.
[CUSTOMER][NEUTRAL] Insurance phone number, rep's name. Oh, you got a claim number there? Yeah, oh, you gave me a claim number, didn't you? Yeah, I got the claim number.
[AGENT][NEUTRAL] Yes, I did.
[CUSTOMER][NEUTRAL] Uh, date received.
[CUSTOMER][NEUTRAL] You got, you got the date you got the date received, yes, December, no.
[CUSTOMER][NEUTRAL] Yeah, receive date
[AGENT][NEUTRAL] Let me give that to you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] We received it on [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that would have been the same day that the other one was paid.
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Primary payer, I got that method for sending. I got that. You don't need the UBO4, do you?
[AGENT][NEUTRAL] No, sir, because that was sent in with the first initial claim, but we have a payer ID number if you want that if you wanna send it electronically.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, let me put that on the list as well and then those in control of that can figure out how they wanna do it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Say your ID, OK, yeah, let me have that.
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] But, but, well, wait, but I'm sending an EOB. I can't send an EOB over with a payer ID, do I?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] No, that's just for like money.
[AGENT][NEUTRAL] No, uh, no, it's for claims.
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] Oh, OK, well I'll put that on there too sorry.
[AGENT][NEUTRAL] 6
[AGENT][NEUTRAL] Yes, sir. Yes, sir.
[CUSTOMER][NEUTRAL] Alright, payer ID what?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Beautiful then
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] I, I missed your name in the beginning of the call. What was it?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And you got a caller reference number?
[AGENT][NEUTRAL] Yes sir, you can use my name and today's date.
[CUSTOMER][POSITIVE] OK, well thank you very much for helping me walk through this story. I really appreciate it, OK, and make sure.
[AGENT][POSITIVE] It's not a problem at all. We, we all need help sometimes and I'm glad I was able to help you.
[CUSTOMER][POSITIVE] OK, well you you have a good rest of the day, right? Like I said, I really appreciate it OK bye bye.
[AGENT][NEUTRAL] You too, sir.
[AGENT][POSITIVE] No problem at all alright [PII], you take care have a good rest of the week. Thanks for calling APL.
[AGENT][NEUTRAL] Bye-bye, sir.
[CUSTOMER][NEUTRAL] So.