AccountId: 011433970860
ContactId: 023d2a60-f3d4-4991-a8e8-3369719639fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 715349 ms
Total Talk Time (AGENT): 144791 ms
Total Talk Time (CUSTOMER): 108534 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/023d2a60-f3d4-4991-a8e8-3369719639fc_20250403T20:28_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, hi, this is [PII] calling from the business office of West Boca Medical Center checking for an appeal status for claims.
[AGENT][NEUTRAL] OK, I can definitely help you with your appeal, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], direct line. And the ID number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 11
[CUSTOMER][NEUTRAL] And [PII] number 7.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. The birth is [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 for the claim and the total bills?
[CUSTOMER][NEUTRAL] The day of service is [PII]. toll charge.
[CUSTOMER][NEUTRAL] $16,0065 even.
[AGENT][NEUTRAL] Thank you and again just for the call, the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I locate that claim.
[AGENT][NEUTRAL] And the appeal?
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Let me see what this one is. Hold on one moment.
[AGENT][NEUTRAL] OK, so this is the original.
[CUSTOMER][NEUTRAL] And I'm checking for in the bill status.
[AGENT][NEUTRAL] I understand. I'm just trying to get all the claim information. Hold on one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes hello?
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. I had to do a little bit of searching, but we received the appeal.
[AGENT][NEUTRAL] On
[AGENT][NEUTRAL] So.
[AGENT][NEUTRAL] We received the appeal on we received the appeal on [PII].
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] The claim number is 348.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1435.
[AGENT][NEUTRAL] And on [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Then the claim was denied.
[AGENT][NEUTRAL] As miscellaneous correspondence and referred to the original claim which the max was paid out on?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And when was the claim denied?
[AGENT][NEUTRAL] The claim was denied on [PII].
[CUSTOMER][NEUTRAL] And can you repeat the denial reason again?
[AGENT][NEUTRAL] It was denied as miscellaneous correspondence with a reference to the original claim number which was which the max was paid.
[CUSTOMER][NEUTRAL] And to original.
[CUSTOMER][NEUTRAL] Queen number.
[CUSTOMER][NEUTRAL] Max for maximum be.
[CUSTOMER][NEUTRAL] OK, so you mean the appeal was upheld?
[AGENT][POSITIVE] Correct, because the max on the original claim was paid out already.
[CUSTOMER][NEUTRAL] I you.
[CUSTOMER][NEUTRAL] I make sure that
[CUSTOMER][NEUTRAL] You to was over and is this a final level of appeal?
[AGENT][NEUTRAL] I mean, so you can appeal, you can appeal as much as you like, um, however, in the original claim, the max was paid, so we can't pay more than the max.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Excellent.
[CUSTOMER][NEUTRAL] And may I have the document number?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Uh, let me see, so there's really no dock number because it was.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Uh my name is [PII] and then she was my last name.
[CUSTOMER][NEUTRAL] That I'm calling from
[CUSTOMER][NEGATIVE] And they're checking for meals that it's returning.
[CUSTOMER][NEUTRAL] Everybody
[AGENT][NEUTRAL] Yeah, so this one was there's no doc number for this because it was, it was filed as a uh um.
[AGENT][NEUTRAL] It's not really a decision. It's just referring back to the original that was.
[AGENT][NEUTRAL] The max was paid. Um, let me reach out to claims and see if there's another number that I can give as the doc number. Um, hold on one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, hello, [PII], thank you so much for holding again. I just spoke with claims and so the only number that we have is the claim number.
[CUSTOMER][NEUTRAL] Call from here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you, and that would be all. Do you have a call reference?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] And they also have
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you, have a great day bye.
[AGENT][POSITIVE] Thank you. You're welcome and thanks for calling APL. Bye-bye.