AccountId: 011433970860
ContactId: 13c70cc1-6568-441a-ae52-cbdce3d9e682
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 638979 ms
Total Talk Time (AGENT): 223236 ms
Total Talk Time (CUSTOMER): 152789 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/13c70cc1-6568-441a-ae52-cbdce3d9e682_20250514T20:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi sorry I think I was just talking to you.
[AGENT][NEUTRAL] Oh, I think so too.
[CUSTOMER][NEUTRAL] Uh, this is [PII] calling for HCA Florida Northwest Hospital.
[AGENT][POSITIVE] Yes, ma'am. I am so sorry about my line being messed up. Is it better?
[CUSTOMER][NEUTRAL] Oh yeah I can I can still hear it like kind of trying, but so far I can understand what you're saying so.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, awesome, awesome. OK. I think we had a bad connection. OK, so you're looking for claim status. What is the um patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] That's better to me.
[CUSTOMER][NEUTRAL] Alright, name is [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, date of birth is [PII].
[CUSTOMER][NEUTRAL] And policy number is 02518304.
[AGENT][NEUTRAL] OK, let me look him up real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then may I have [PII]'s date of service and charge amount?
[CUSTOMER][NEUTRAL] Yes, um, so data service is gonna be for [PII].
[CUSTOMER][NEUTRAL] And total charge is $285,432 even.
[AGENT][NEUTRAL] OK, and then [PII], what were the charges after the primary paid?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] See
[CUSTOMER][NEUTRAL] So primary paid $39,541.17.
[CUSTOMER][NEUTRAL] And it looks like they left a patient responsibility of $6,598.94.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a quick hold while I look up this claim and I'll be right back with you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, Ms. [PII] looking at the claim um I've got the information for you. The claim number is 355.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 876 4.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim was denied because the primary insurance paid the benefits and there was no, no um responsibility left for deductible co-pay or co-insurance says primary insurance provided full benefits. There are no benefits payable.
[CUSTOMER][NEUTRAL] Primary, OK.
[CUSTOMER][NEUTRAL] And you're showing their full payment should have been the $39,541 because we have that their expected payment was $46,140.01 and then they left that $6000.
[AGENT][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Uh, $598 patient responsibility.
[AGENT][NEUTRAL] OK, so, um, the way that this policy works, um, we're, we base what we pay on the EOB from the primary as far as deductible, co-pay or co-insurance. So on this one, the insured's primary insurance provided full benefits and there are no benefits payable.
[CUSTOMER][NEUTRAL] OK, because the EOB that you're looking at doesn't show a patient responsibility.
[AGENT][NEUTRAL] We don't do patient responsibility we let the provider determine the patient responsibility.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Well, the, the patient responsibility would be the like the deductible, the co-insurance, like the what the primary applied it to.
[AGENT][NEUTRAL] Right, and this is stating that the um primary provided those benefits. Therefore, there's nothing left to pay.
[CUSTOMER][NEUTRAL] OK, I'm a little bit confused because the primary pay, but they left the patient responsibility, which should be what the secondary covers.
[CUSTOMER][NEUTRAL] Is it a limited plan, limited benefit plan?
[AGENT][NEUTRAL] Yes, ma'am, um, they have limited.
[CUSTOMER][NEUTRAL] Because you're stating that you guys pay the patient responsibility, the coinsurance, or the deductible, but then you're saying that.
[CUSTOMER][NEGATIVE] That's not the case for this one.
[AGENT][NEUTRAL] Right, because on the EOB that we received with the client, the primary paid it so.
[AGENT][NEGATIVE] There was no benefits payable.
[CUSTOMER][NEUTRAL] And what is your EOB EB that you received from the primary payer, what is that showing because like I said, there's a patient responsibility, so they didn't pay at all. There's there's still a balance owed.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I understand that so what I'm going to do because I don't see the EOB myself I'm gonna go ahead and transfer you to a claim specialist so that they can go over the claim with you and let you know what was received and why they came with the remark that they did, OK?
[CUSTOMER][NEUTRAL] OK, and, uh, before you transfer me, can you give me the receipt date of the claim and a call reference number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Sure, absolutely.
[AGENT][NEUTRAL] Uh, let me get the received date for you.
[AGENT][NEUTRAL] Give me just a minute while I search for it.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] We received the claim on [PII] and paid for it on our processed it, not paid it, processed it on [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome and um you asked one more question. What was the other question?
[CUSTOMER][NEUTRAL] Um, the call reference number.
[AGENT][NEUTRAL] Yes, ma'am. That would be my name, [PII] and today's date.
[CUSTOMER][POSITIVE] OK, perfect, great, thank you so much.
[AGENT][POSITIVE] You're welcome and it's gonna be a brief hold while I transfer you on over to a claims specialist. Thank you so much for calling Miss [PII]. I hope you have a good day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. You too. Thank you so much.
[AGENT][NEUTRAL] Bye-bye, ma'am.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Thanks for calling APO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, Ms. [PII], it's [PII]. Sorry to bother you. I've got a provider on the phone and she is calling about claim number 3558764 on policy 2518304 for part one.
[AGENT][NEUTRAL] I read her the remarks that um the provider provided full benefits and there's nothing left to pay and she is, she's going back and forth with me. She's not quite getting it, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She's going to speak to you, so maybe you can explain it to her better.
[CUSTOMER][NEUTRAL] OK, 1 2nd.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you can send her on over.
[AGENT][POSITIVE] OK, thank you so much, Ms. [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] OK