AccountId: 011433970860
ContactId: 05f09c74-acde-4c5f-84bf-00874ab46328
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 547080 ms
Total Talk Time (AGENT): 159409 ms
Total Talk Time (CUSTOMER): 191268 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/05f09c74-acde-4c5f-84bf-00874ab46328_20250512T14:07_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help?
[CUSTOMER][NEUTRAL] Hi [PII], your phone is breaking up just a bit. Can you hear me OK?
[AGENT][NEUTRAL] Yes, I can hear you OK. Can you hear me?
[CUSTOMER][NEUTRAL] Yes, I can hear you a little better now. Um, [PII], my name is [PII] I'm calling from Nova Southeastern University regarding some claims. I'm just trying to verify if you guys have them on file.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I can check your claims for you and you said your name was [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. And Miss [PII], what is your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My direct number is [PII].
[AGENT][NEUTRAL] Thank you and then what's the patient's name, date of?
[AGENT][NEUTRAL] Birth and policy number?
[CUSTOMER][NEUTRAL] OK, the first name is [PII], that's [PII]. I have [PII] for the last name.
[CUSTOMER][NEUTRAL] Date of birth is [PII] and the policy number I have is 02478728 M like in Mary, L as in Lima 8.
[AGENT][POSITIVE] OK, thank you. Let me look that up real quick.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][NEUTRAL] OK, and then on uh Ms. [PII], what is the date of service of the claim and the charge amount?
[CUSTOMER][NEUTRAL] Sure, the first date of service in question is [PII]. Bill amount is for $340.
[AGENT][NEUTRAL] OK and then what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Um, it's $35.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I'm gonna put you on a quick hold while I look up this claim for us and I'll be right back.
[CUSTOMER][POSITIVE] OK, sure. Thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you so much for holding for me. On that date of service, uh, [PII] for Ms. [PII], I'm not finding the claim on file for that date of service.
[CUSTOMER][NEUTRAL] OK. Thank you. I just wanted to make sure that, um.
[CUSTOMER][NEUTRAL] Do you mind if we look into one more?
[AGENT][NEUTRAL] Sure, what's the date of service for the next one?
[CUSTOMER][NEUTRAL] Um, let's take a look at, uh, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, bill amount is for $347 even.
[AGENT][NEUTRAL] OK, and then the charges.
[CUSTOMER][NEUTRAL] And I believe the charge would have been for the copay.
[CUSTOMER][NEUTRAL] Yeah, the copay of $35.
[AGENT][NEUTRAL] OK, and what
[AGENT][NEUTRAL] $35. OK, and is it for the same member?
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] OK, alright, I'm gonna put you on a quick hold. I'm gonna check this one out and I'll be right back with you.
[CUSTOMER][POSITIVE] Perfect, thank you. You are on hold.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Thank you for holding for me Miss [PII]
[AGENT][NEUTRAL] So looking on that data service of [PII], I do not find the claim on file for the amount that you've given me.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, do you guys accept um electronic, um, claims?
[AGENT][NEUTRAL] Yes ma'am, we do. Would you like the payer ID number?
[CUSTOMER][NEUTRAL] Um, I have one, but I'm not sure. Is there any way you can confirm what we have?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. It's 60801.
[CUSTOMER][NEUTRAL] OK, so that's what we've sent that one, the one I just sent you, we sent it to you on 3-12-2025 to that payer ID.
[CUSTOMER][NEUTRAL] Um, but I'm not sure why you don't have it. That's really weird.
[AGENT][NEUTRAL] I have a claim on that data service for but it's for a different amount. Let me see if it's for you.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] By any chance,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] On the second one, the first one's not there at all.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, ma'am. It's not for your facility.
[CUSTOMER][NEUTRAL] OK. Let me ask you, um.
[CUSTOMER][NEUTRAL] So we have the payer ID right? I'm not sure why you guys haven't received it. What is your claims address if you don't mind me asking?
[AGENT][NEUTRAL] That is [PII]. That's in [PII], and the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, perfect. I'm not really sure what's going on. They are sending electronic. I'm just afraid to send it again and you don't have it and we run into timely filing. Do you guys usually cover the patient's co-pay cause that's all I'm seeing that you see um her, uh, balance is for. Is that something that you guys cover or you guys just cover anything that that the insurance doesn't cover?
[AGENT][NEUTRAL] Uh, this is just to verify benefits. It's not a guarantee of payment. This policy is a supplemental policy that helps with deductible co-pay and co-insurance only.
[CUSTOMER][NEUTRAL] Oh, OK. Gotcha. Gotcha, gotcha. All right. um Mhm.
[AGENT][NEUTRAL] And it's OK to go ahead and resend the claim. We don't have a timely filing limit so if you wanted to go ahead and resubmit it, that would be fine.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, perfect. That was, that was my next question. Um, alright, perfect and just to confirm, payer ID is 60801.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Perfect. Alright, [PII], thank you so much for looking into those two claims for me. I'll go ahead and resubmit those back out to you guys. Is there a call reference number I can have?
[AGENT][NEUTRAL] Yes, you can use my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] today's day. Perfect. Thank you so much. You have a great rest of your day, OK?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] You too, Q. Is that everything I can help you with before we go?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, ma'am, you've been great. Thank you.
[AGENT][POSITIVE] Thank you, ma'am. I hope you have a wonderful rest of your week and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you, you too.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] All righty. Thanks. Bye-bye.