AccountId: 011433970860
ContactId: 1589efea-c438-4829-bde5-8962a813ef58
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 779549 ms
Total Talk Time (AGENT): 284344 ms
Total Talk Time (CUSTOMER): 271397 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/1589efea-c438-4829-bde5-8962a813ef58_20250520T17:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, hi [PII], this is [PII]. I'm calling on behalf of uh HCA Florida University Hospital provider's office, and I'm trying to check claim status. I'm not sure if I'm the right area.
[AGENT][NEUTRAL] OK. May I please have the callback number and then the policy number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the policy number is 02249087ML7.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], born [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Almost in [PII].
[AGENT][NEUTRAL] And thank you so much, [PII] for verifying the policy. You're calling in for a status of claim. May I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure thing, can I get your name one more time?
[AGENT][NEUTRAL] Yes, it is [PII]. Would you like for me to spell that for you?
[CUSTOMER][NEUTRAL] With a [PII] or a [PII]?
[AGENT][NEUTRAL] It is spelled [PII] with the last initial of 8 and today's date will be used as the call reference.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK [PII], thank you for that. um, OK, the date of service is, um, [PII].
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Total bill, please.
[CUSTOMER][NEUTRAL] And the total amount is 13, yeah $13,432.
[AGENT][NEUTRAL] Sorry.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] There's a delay on the phone, so I'm apologizing up front if I step on you when you're talking and you don't have to apologize to me either because it happens all the time.
[AGENT][POSITIVE] No problem.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And it does look like we did receive that claim in.
[AGENT][NEUTRAL] Let me pull the information up for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I see this correspondence from you all and it says that uh like you've got a an explanation of benefits but it doesn't um it doesn't list everything properly and I have a.
[CUSTOMER][POSITIVE] Uh, primary EOB here from great.
[CUSTOMER][NEUTRAL] What is it called, uh, Great Western Healthcare that lists everything perfectly. Did you get that and that is not, uh, the the thing you're looking for, or do you need like this primary EOB that I have?
[AGENT][NEUTRAL] Let me pull that up for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Cause it doesn't look like we received it in twice.
[CUSTOMER][NEUTRAL] I'm over it.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] He received the same EOB twice.
[AGENT][NEUTRAL] It's like we received the claim in twice, so I'm pulling both of the images up to review it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, OK, OK.
[CUSTOMER][NEUTRAL] What state are you in [PII]?
[AGENT][NEUTRAL] I am in [PII].
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] I'd tell you where I am, but I'm offshore and we can't say where we are but.
[CUSTOMER][NEUTRAL] I'm not in the [PII], but I grew up there.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, it is um it I'm in the area where our company is located.
[AGENT][NEUTRAL] So yeah, it would be [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's one of the states I did not visit everything around it, but I never got to [PII].
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So for the first.
[AGENT][NEUTRAL] Image. Well, actually for the last image when we received it, it does look like it did have the doc the information that was needed. But when we received it, it, we also requested the updated W9.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so since we didn't receive that information because it was processed on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You the process date.
[CUSTOMER][NEUTRAL] W 9 OK.
[AGENT][NEUTRAL] It was processed on [PII] actually we just recently processed it and we were requesting for the updated W-9.
[CUSTOMER][NEUTRAL] OK, uh, requesting.
[CUSTOMER][NEUTRAL] W 9
[CUSTOMER][NEUTRAL] Uh, when was this received?
[AGENT][NEUTRAL] That one was received on [PII].
[CUSTOMER][NEUTRAL] OK, can I get the claim number too, please?
[AGENT][NEUTRAL] Yes, that claim number is showing as 360.
[AGENT][NEUTRAL] 2511.
[CUSTOMER][NEUTRAL] In
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One second here let me get my notes in order.
[CUSTOMER][NEUTRAL] The claim number processed.
[CUSTOMER][NEUTRAL] And is it denied or is it just pending?
[AGENT][NEUTRAL] It is showing that it's denied. Let me give you the correct informa you know, the information on the wording for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So since we, this is given a B notice discrepancy, so with it given a B notice discrepancy where we're needing the updated W-9, then that payment actually went to the insured, so the provider will have to contact the insured in regards to that payment.
[CUSTOMER][NEUTRAL] OK, so, um, it's denied requesting updated W-9, uh, you're saying the payment was made?
[AGENT][NEUTRAL] Yes, the payment was issued since there was a discrepancy be notice discrepancy, then we have to submit that payment over to the insured. So then that's when the provider will have to discuss that payment with the insured.
[CUSTOMER][NEUTRAL] OK, uh, so when was this payment issued and for how much was it?
[AGENT][NEUTRAL] That was issued. Now, with the payment amount, I can't disclose that since it did go to the insured, but we did process that claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it is, so the, the, uh, the payment was issued to the patient.
[CUSTOMER][NEUTRAL] Um,
[AGENT][POSITIVE] Yes, to the insured, yes.
[CUSTOMER][NEUTRAL] Can you give me a check number or anything like that?
[AGENT][NEUTRAL] I can't disclose that information. Now, if it would have went to the provider, then I can give you that, but since this is to the insured, I can't disclose that information.
[CUSTOMER][NEUTRAL] OK, OK, yeah.
[CUSTOMER][NEUTRAL] OK, that's fine.
[AGENT][NEUTRAL] But if you was also needing to pull, if you were also needing to pull that EOB up since you will receive that denial, you can actually go on to our secured portal and you will be able to use that claim number that I gave you and you will be able to pull that EOB to show the reason of the denial and what information is actually needed to enter and update our system.
[CUSTOMER][NEUTRAL] OK, let me check on a scenario.
[CUSTOMER][NEUTRAL] OK, you, you cannot send me the, the EOB. I have to go through the uh portal?
[AGENT][NEUTRAL] Yes, you would have to go through the portal or you will have to wait until you receive that EOB.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK um.
[AGENT][NEUTRAL] Let me see if I have the provider. Let me see if I have an image of the provider EOB. Let me check that for you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And if you could give me the portal uh address as well.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Just so I have it on my records here and I can update my uh my.
[AGENT][NEUTRAL] That portal is.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] The porter is secured, that is spelled [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I am able to submit this EOB over since I did find the provider EOB. May I have a fax number?
[CUSTOMER][POSITIVE] Yes, that'd be great thank you.
[CUSTOMER][NEUTRAL] Um, let me get that fax number for you.
[CUSTOMER][NEUTRAL] Here we go, it's [PII].
[AGENT][NEUTRAL] And that's to the attention of Edward.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] OK. And I will get that submitted over to you. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Let me check on something here while I have you just uh check on my my scenarios here for W9.
[CUSTOMER][NEUTRAL] Maybe I can get that over to you.
[CUSTOMER][NEUTRAL] OK, one second.
[CUSTOMER][NEUTRAL] Let me just, uh, give me one second. I'm gonna put you on a silent hold while I look through, uh, some scenarios here.
[CUSTOMER][NEUTRAL] Uh, just to see if I can how to get you the W-9 if that's what's necessary, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Could I get a uh fax or a way I can get you that W9 if I can get a hold of it?
[AGENT][NEUTRAL] Yes, let me get that information for you and I can also submit over the letter that was actually submitted out as well in order for you to see what information is needed because it's showing something.
[AGENT][NEUTRAL] It's actually a, it's, it's more detailed on what documentation would need to be submitted in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] But I can go ahead and give you the facts as well. Are you ready for that?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It is 877.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] 877
[CUSTOMER][NEUTRAL] 365
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, um, so you're saying that there's a more it's not just the W-9 that's that needs to be sent over more details. There's more details that are in the EOB and I'm going to wait on that EOB so I can see exactly what is needed, OK?
[AGENT][POSITIVE] Yes, yes, I will get that over to you and is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] No, that's fine, thank you very much for now. That's good enough. I really appreciate your, uh, time and patience, [PII].
[AGENT][POSITIVE] You're so welcome, [PII], and I do want to thank you for calling American Public Life. You have a great rest of your day.
[CUSTOMER][NEUTRAL] Hey you too bye bye.
[AGENT][POSITIVE] Thank you. Bye.