AccountId: 011433970860
ContactId: 020081cf-6ef5-4599-88ca-651c32d19b34
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1437430 ms
Total Talk Time (AGENT): 382005 ms
Total Talk Time (CUSTOMER): 298193 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/020081cf-6ef5-4599-88ca-651c32d19b34_20250522T17:43_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] Yeah. Hi, [PII]. This is [PII] calling from provider office to check the claim status.
[AGENT][POSITIVE] OK, well I'll be more than happy to help you with the claim status and [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] I do have 4, sorry, 5 clients.
[AGENT][NEUTRAL] And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] The callback number is [PII].
[AGENT][NEUTRAL] Thank you. May I have the first member's policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 017.
[CUSTOMER][NEUTRAL] 189
[CUSTOMER][NEUTRAL] 38
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. The date of birth is on [PII].
[AGENT][POSITIVE] Thank you
[AGENT][NEUTRAL] Um, can you say the date of birth again? I'm sorry?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] What's the first and last name?
[AGENT][NEGATIVE] I'm asking because it's not matching.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that was policy number 1718938.
[CUSTOMER][NEUTRAL] Yeah, 017918938. Yeah.
[AGENT][NEGATIVE] Hold on. 0179. Say that again because that is not correct. Say that again.
[CUSTOMER][NEUTRAL] 019
[CUSTOMER][POSITIVE] Sorry, 017. Sorry about that.
[AGENT][NEUTRAL] 0179, mhm.
[CUSTOMER][NEUTRAL] 9189.
[CUSTOMER][NEUTRAL] Yeah, 01791893. M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, here we go. 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] Yeah, it's on [PII].
[CUSTOMER][NEUTRAL] With the amount is $39,176 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And are you needing the original claim status or the um corrected claim?
[CUSTOMER][NEUTRAL] No, it's uh, uh, can you verify the claim number is 349-0315.
[AGENT][NEUTRAL] OK, I'm at, so that's the original claim that was denied because the explanation of benefits from primary insurance is needed. It was then we received it again. Are you
[AGENT][NEUTRAL] Asking for the original claim or the second claim that we received.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, after that 2nd time.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so you received the second claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3602866.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, we can, uh.
[CUSTOMER][NEUTRAL] May I know how much is the outpatient limit?
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] It's $1500 per calendar year.
[CUSTOMER][NEUTRAL] And it was met, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And uh may I know when it was uh met as lastly?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Um hm.
[AGENT][NEUTRAL] How can I do this? Hold on one second.
[AGENT][NEUTRAL] Let me see if it's the same provider.
[AGENT][NEUTRAL] Um, I'll just say the date was, uh, [PII] was the date that we processed the claim that maxed the benefits out.
[CUSTOMER][NEUTRAL] And it was received on [PII], right?
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The claim is not your, is not a claim of your provider.
[CUSTOMER][NEUTRAL] Oh yeah, OK. Yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah, that's it and uh
[CUSTOMER][NEUTRAL] Can we move on to the another claim?
[AGENT][NEUTRAL] Um, hold on one moment. I have to note each claim. Hold on one second.
[CUSTOMER][POSITIVE] Yeah, yeah. OK. Take your time.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah, it's 024.
[CUSTOMER][NEUTRAL] 078
[CUSTOMER][NEUTRAL] 96
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, #7.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is on [PII].
[AGENT][NEUTRAL] Thank you. May I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] It's [PII]. The double amount as $20,537 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] Oh, that's not enough. Hold on one moment.
[AGENT][NEUTRAL] And the original.
[AGENT][NEUTRAL] And are you wanting the original claim or the um reprocessed claim?
[CUSTOMER][NEUTRAL] Reprocess the claim.
[AGENT][NEUTRAL] All right, hold on one moment.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Yeah, I'll get there.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah, uh-huh mm.
[AGENT][NEUTRAL] Oh. OK, wait a minute. 20,485.
[AGENT][NEUTRAL] It's not the same as the 20,000.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah, I'm still here.
[AGENT][POSITIVE] Thank you so much for holding. Is $20,537 the only total bill or could there be another amount?
[CUSTOMER][NEUTRAL] 20,000. Sorry for that, 2,020,000?
[AGENT][NEUTRAL] $537.
[CUSTOMER][NEUTRAL] Yeah, it's like $20,500. Just a moment. So sorry for that. Uh, it's $20,485 even. Sorry.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's HCA Florida Palms West Hospital.
[AGENT][NEUTRAL] Alright, so I'm trying to receive the reprocessed claim on [PII].
[AGENT][NEUTRAL] The claim number is 360.
[AGENT][NEUTRAL] 2654.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider, a total of $662.97.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Did you need the checking information?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so this is a single check?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Check number 2045023.
[CUSTOMER][NEUTRAL] And the claim was allowed us to $662.97 right? And with no personal responsibility, right?
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] We don't determine patient responsibility.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, OK. And uh can you, um,
[CUSTOMER][NEUTRAL] Tell me the, oh sorry, can you verify the address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, OK. And can you, can, may I know the
[CUSTOMER][NEUTRAL] Issue date and whether it was cashed or not.
[AGENT][POSITIVE] It was just issued on [PII]. It is still outstanding.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah, OK. And uh can you move on to the next class?
[AGENT][NEUTRAL] Sure, hold on one moment, let me note this policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] 024
[CUSTOMER][NEUTRAL] 465
[CUSTOMER][NEUTRAL] 28
[AGENT][NEUTRAL] 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] It's [PII], and the date of birth is on [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Uh, the, uh, the date of service is on [PII].
[CUSTOMER][NEUTRAL] A double the amount is $34,976 even.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] Oh sorry for that. Uh, the total bill amount is $24,307 even.
[AGENT][NEUTRAL] $24,307.
[CUSTOMER][POSITIVE] Yeah, great.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And would this be the same provider?
[CUSTOMER][NEUTRAL] Mm, no, it's for the it's Trident Medical Center.
[AGENT][NEUTRAL] Alright, I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 355-0711.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[AGENT][NEUTRAL] Requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, OK. And we have already submitted that, uh uh do you receive a primary before this claim and it was submitted through the
[CUSTOMER][NEUTRAL] Uh, fax number is [PII]. Did you receive that?
[AGENT][NEUTRAL] No, we haven't, um, but you can resubmit that and we'll continue processing.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] To the same fax number, right?
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] Or um mail or pay ID.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah, OK. And you will send my that.
[CUSTOMER][NEUTRAL] And uh can you move on to the next one?
[AGENT][NEUTRAL] Yes, please allow me just a moment so I can note the policies when we're finished.
[CUSTOMER][POSITIVE] No, sir. Sure, sir. Take your time, take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and the next number?
[CUSTOMER][NEUTRAL] Yeah, the member ID has.
[CUSTOMER][NEUTRAL] 010
[CUSTOMER][NEUTRAL] 71065.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is on [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] The data services on
[CUSTOMER][NEUTRAL] [PII] with the bill amount as $4,162.75.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on this claim?
[CUSTOMER][NEUTRAL] So HSCF Florida Woodmont Hospital.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And you're needing the second claim?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, so you received the second claim on [PII].
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] 5746.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the maximum amount payable for this occurrence has been met.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, and the last claim number?
[AGENT][NEUTRAL] Or a policy number, I'm sorry.
[CUSTOMER][NEUTRAL] The member ID.
[CUSTOMER][NEUTRAL] Yeah. It's 024.
[CUSTOMER][NEUTRAL] 57037.
[AGENT][NEUTRAL] 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] It's [PII].
[CUSTOMER][NEUTRAL] The date of birth on July.
[CUSTOMER][NEUTRAL] I'm sorry. [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 total bill?
[CUSTOMER][NEUTRAL] Data services on [PII], with the amount of $5,549 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so we've only received one claim for this um data service. Uh, we received the claim on [PII].
[AGENT][NEUTRAL] That claim number is 35, I'm sorry, 352.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 78887.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] And we will send the primary for this to, to the same fax number that you provided.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Mm, yeah, OK. And uh
[CUSTOMER][NEUTRAL] Is there any timeters in the primary?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Is there any time limit to send the primary OB?
[AGENT][NEUTRAL] No, there's no timely filing, but this is additional information. So as soon as we receive it, we'll continue processing.
[CUSTOMER][NEUTRAL] Yeah, OK, [PII].
[CUSTOMER][NEUTRAL] And uh yeah. Mm.
[CUSTOMER][NEUTRAL] We got all the information about the 5 clients. Can I get the color ones?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date, and the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Yeah, OK, I know. That's what I'm thanking for assistance.
[AGENT][POSITIVE] Alrighty.
[AGENT][POSITIVE] Well, you're very welcome and thanks for calling APL [PII]. I hope you have a good day.
[CUSTOMER][POSITIVE] Yeah, you too. Have a good day, bye.
[AGENT][POSITIVE] Thank you, bye bye.