AccountId: 011433970860
ContactId: 0f81d69a-a2bb-4251-84f1-d1a20c43a87d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 375260 ms
Total Talk Time (AGENT): 149505 ms
Total Talk Time (CUSTOMER): 130234 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/0f81d69a-a2bb-4251-84f1-d1a20c43a87d_20250304T14:56_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on the denial reason of the claim. Could you please assist me, assist me with that?
[AGENT][NEUTRAL] Sure, I can verify claim status for you. And you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, and what is the policy number, please?
[CUSTOMER][NEUTRAL] Yes, the policy number is 2263406.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes. Callback number is
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. That's a direct line, no extension.
[AGENT][NEUTRAL] OK, thank you, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Yes. The patient name is [PII] and last name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] OK, and do you have a claim number or what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] The claim number is 354.
[CUSTOMER][NEUTRAL] 8692.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] For data service [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and you're calling from?
[CUSTOMER][NEUTRAL] I'm calling from HCA Florida JFK Hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have the balance after primary?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and that amount is?
[CUSTOMER][NEUTRAL] Uh, for this claim, the bill amount is
[CUSTOMER][NEUTRAL] $41,783 even.
[AGENT][NEUTRAL] No, uh, do you have the balance after primary insurance has processed the claim?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It is, uh, here it is showing as $2,271.83.
[AGENT][NEUTRAL] OK. Give me a moment.
[AGENT][NEUTRAL] OK, it showed the claim initially, uh, showed the claim initially processed as needing primary insurance explanation of benefits and it looks like we received that and a claim or payment was sent.
[CUSTOMER][NEUTRAL] Actually, for
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the amount of $1,709.17 and with the payment of that claim max their outpatient benefit for the year.
[CUSTOMER][NEUTRAL] So this claim is paid?
[AGENT][NEUTRAL] Yes, initially, the claim processed as needing the primary EOB which we received, and so the claim was processed on [PII] and the check was mailed in the amount of $1,709.17.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. What is the allowed amount actually for you?
[AGENT][NEUTRAL] There's not allowed amount. There's just the amount that we will pick up and pay.
[CUSTOMER][NEUTRAL] OK. It's uh is uh like what is the allowed amount from the facility you have?
[AGENT][NEUTRAL] We don't have an allowed amount. We have an amount that we will pay. Uh secondary, we pick up what primary applied towards deductible, co-pay or co-insurance, and with this payment, it mas their outpatient benefit for the year, so we don't have an allowed amount.
[CUSTOMER][POSITIVE] It is safe.
[CUSTOMER][NEUTRAL] OK. What is the patient responsibility? How much is the patient responsibility?
[AGENT][NEUTRAL] We don't give patient responsibility. We only verify how the claim was processed.
[CUSTOMER][NEUTRAL] OK. Claim was paid on [PII], right?
[AGENT][POSITIVE] Correct, yes, ma'am.
[CUSTOMER][NEUTRAL] OK. Through check.
[AGENT][NEUTRAL] The paper check, single paper check.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I get the check number?
[AGENT][NEUTRAL] Check number is 2,029,310.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is it single check, right?
[AGENT][NEUTRAL] Single check, correct.
[CUSTOMER][NEUTRAL] OK. When it is issued?
[AGENT][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] It is not yet cleared, right?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is the bill amount?
[AGENT][NEGATIVE] I'm not understanding what you're asking.
[CUSTOMER][NEUTRAL] OK. Can you fax me the UB for this claim?
[AGENT][NEUTRAL] Uh, we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[CUSTOMER][NEUTRAL] OK. May I get the claim received date actually, when it was received?
[AGENT][NEUTRAL] The claim was received on [PII].
[CUSTOMER][POSITIVE] Thank you so much for your time and assistance. May I get the call reference?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name at today's date. And is there anything else I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] No, thank you so much for your time and assistance. Have a great day. Bye.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Yes.