AccountId: 011433970860
ContactId: 1a817742-8fc4-4107-9b5e-5b3e94dc9ef8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1721859 ms
Total Talk Time (AGENT): 482801 ms
Total Talk Time (CUSTOMER): 324182 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/1a817742-8fc4-4107-9b5e-5b3e94dc9ef8_20250422T17:21_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from the priority's office to check on the general claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][POSITIVE] Yes, and a good callback number is [PII]. It's a direct line.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Quality holder number is 02335900.
[CUSTOMER][NEUTRAL] M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[AGENT][NEUTRAL] OK, can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes. Give me a moment.
[CUSTOMER][NEUTRAL] And the member's first name is [PII] and the last name is
[CUSTOMER][NEUTRAL] [PII], [PII]
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] [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 and the total bill for the claim you like me to take a look at?
[CUSTOMER][NEUTRAL] [PII] and the total charge was $8,404 even.
[AGENT][NEUTRAL] Thank you. And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] HCF Florida Palm West Hospital.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 963-3.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting an explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Yes, actually we have submitted the primary UB via fax on, I'll just let you know, OK?
[AGENT][NEUTRAL] I was gonna say we received it on [PII]. That claim number is 3,591,900.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And on April
[CUSTOMER][NEUTRAL] Received on which date April?
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] which date did you receive that?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3,591,900.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider a total of $500.
[CUSTOMER][NEUTRAL] Paid which uh how much amount?
[AGENT][NEUTRAL] $500.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Did you need the check information?
[CUSTOMER][NEUTRAL] Yes, and give me a moment, paid $500 right, even. And what is your pay uh allowed amount?
[AGENT][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Date of birth, [PII].
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] So the benefit um is up to $500 per calendar day, so the, I guess the allotted amount would be $500.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. What is the patient responsibility?
[AGENT][NEUTRAL] We don't determine patient responsibility because we're not the major medical insurance company.
[CUSTOMER][NEUTRAL] So we billed this much amount and give me a moment.
[CUSTOMER][NEUTRAL] R.
[CUSTOMER][NEUTRAL] There is no patient responsibility, right?
[AGENT][NEUTRAL] I didn't advise that. I advised that we don't determine patient responsibility.
[AGENT][NEUTRAL] Because we're not a major medical insurance company.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And when was the check was issued?
[AGENT][NEUTRAL] Um, it's check number 2040188.
[AGENT][NEUTRAL] It was a single check?
[AGENT][NEUTRAL] Issued on [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am, of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Single amount of $500 even.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] OK. Yesterday only the check was issued to the which address?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just give me a moment. I'll just verify the address is correct or not.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me a moment.
[CUSTOMER][NEUTRAL] OK, just give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, may I get the call reference number for this call?
[AGENT][NEUTRAL] Yes, the call reference number for the entire call will be my name in today's date, and that's [PII].
[CUSTOMER][NEUTRAL] OK, just give me a moment. I'm just pull up with the other account, OK.
[AGENT][NEUTRAL] Is this the only claim for this policy?
[CUSTOMER][NEUTRAL] Um, I need to pull that information. Just give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The and.
[CUSTOMER][NEUTRAL] Tomorrow.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much for being online. So I can give you the another member ID with a different facility name.
[AGENT][NEUTRAL] And it's a different member?
[CUSTOMER][NEUTRAL] Yes, different member with a different facility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm just asking so I can save these notes. Thank you. And may I have the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yes, and the policy number is 022-03926 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] My first name is [PII]. Last name is [PII], and the date of birth is [PII].
[CUSTOMER][NEUTRAL] I do have
[AGENT][NEUTRAL] Thank you for that. And again, all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and total bills?
[CUSTOMER][NEUTRAL] Date of service was [PII] and the bill amount was $17,356 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] My
[AGENT][NEUTRAL] And what is the name of the provider's office on that claim?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Has a Florida University Hospital.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, [PII], may I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Sure, go ahead.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, what now?
[AGENT][NEUTRAL] So I need to see, wait, no, I had the same total bill.
[AGENT][NEUTRAL] But it was paid to the insured, so I still can't give her that. Where's the next one? Oh, here it is. 3591901.
[AGENT][NEUTRAL] 11901.
[AGENT][NEUTRAL] Oh [PII].
[AGENT][NEGATIVE] Um, where is my guru, girl, girl, girl. Oh, I don't have my, oh, no, I clicked out of it. Oh, it's not gonna work right there.
[AGENT][NEUTRAL] Girl.
[AGENT][NEUTRAL] Do you know
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh gosh.
[AGENT][NEUTRAL] For provided phone calls, we are unable to accept assignment of benefits for the claim filed due to the discrepancy reported by the IRS.
[AGENT][NEUTRAL] Please do the IRS right, uh, I just send you a copy of the updated information.
[AGENT][NEUTRAL] Yeah, you can call his name. OK, you get bounce back office where the email.
[AGENT][NEUTRAL] To [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Please help her get this.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So taking a look at this claim, I do see a message. Um, we are unable to accept assignments of benefits for the claim filed due to a discrepancy reported by the by the IRS. Um, this is a combination of the name and the taxpayer identification number for your account.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Please visit the IRS website for additional information on how to resolve this issue and stop that withholding.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Once this is resolved with the IRS, please send APL a copy of your updated information.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Uh, I didn't get you, sorry. So we need to resubmit the claim once again.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] The IRS has notified us that there's an issue with um the reporting, so there's either an issue with the name, the company name, or the tax ID number on your account. So you will have to reach out to the IRS website to fix that discrepancy and then once it's resolved, send us a copy of the updated information.
[CUSTOMER][NEUTRAL] So, actually, see, we already have everything, UOB claim and uh you need the primary we have stated, we do have the claim number as well. And now again, uh we need to go to the IRS and um how it will be.
[AGENT][NEUTRAL] Right, so at this point it's passed the claim. We can't process the claim because the IRS has notified us that there's an issue with the company name and tax ID number. So once you're the provider, your company gets that resolved, then we would be able to
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] resolve um or continue with the claims, but until then we cannot.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Actually, we do have the another name for this uh policy, sorry, for the facility. It is Dave Medical Center.
[AGENT][NEUTRAL] OK, so we have a representative that works with the um
[AGENT][NEUTRAL] With these pushbacks, did you want for me to send her your information to have them call and give you more information?
[CUSTOMER][NEGATIVE] So, yes, go ahead and transfer this call to your supervisor because it should not be like that, right?
[AGENT][NEUTRAL] Oh, so you want to speak to my supervisor?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, well, hold on one moment and let me get a supervisor for you, OK?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] OK, go ahead, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Here we go.
[AGENT][NEUTRAL] Where's my team.
[AGENT][NEUTRAL] Escalation. Oops.
[AGENT][NEUTRAL] I have.
[AGENT][NEUTRAL] Um, number 045848.
[AGENT][NEUTRAL] Uh uh.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I don't need to go.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] All this extraness.
[AGENT][NEUTRAL] Take the call.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] This is ridiculous. This is not we all is.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for the wait. I'm I'm gonna transfer you over to my supervisor now, OK?
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You're welcome, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello.
[AGENT][NEGATIVE] Hello. And um my team isn't going to allow to connect.
[AGENT][NEUTRAL] Teams
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] I didn't call them teams.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[AGENT][NEUTRAL] [PII], this is [PII] on the care team. Now, you might not be too happy with me after this call, but
[AGENT][NEUTRAL] I have a script reader on the line and their claim was denied for be notice and I read them the, you know, the little remark and Guru for providers. She still didn't understand. I tried to explain it. Well I just said what the statement said just in different words, she still didn't get it. So then I offered to send an email to [PII] for [PII] to call and explain it to her. That's what they said on the guru card, and she's just like, well,
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Um, yeah, get me to your supervisor. I'm like, oh, you want to speak to my supervisor. So [PII] um is having issues with her phone, but she said to get the lady to claim support to talk, she just doesn't understand being noticed.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And she's saying we only have one company and one name and I said, well, that has to be resolved with the IRS and then send us the updated information and we can, you know, continue with the claims, so.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] That's all. She just doesn't get be noticed. And I don't think she unders that's it. You're still my friend?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Yeah, I got you. And there ain't nothing you can do both out of your hands. Go ahead and give me her call back.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it's um.
[CUSTOMER][NEUTRAL] Is that her number on the screen?
[AGENT][NEUTRAL] No, it's [PII].
[CUSTOMER][NEUTRAL] And what's her name?
[AGENT][NEUTRAL] Her name is [PII].
[CUSTOMER][NEGATIVE] [PII], I've talked to [PII] before. She's not pleasant. She can be kind of snotty.
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] That's the truth.
[CUSTOMER][NEUTRAL] What's um what's the policy number?
[AGENT][NEUTRAL] Um, it is 2203926.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me get the claim information, which one?
[CUSTOMER][NEUTRAL] And that's for Mr. [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And is it that claim in 1901?
[AGENT][NEUTRAL] And it's
[AGENT][NEUTRAL] Wait a min[PII] is one of them. Is that the one with the remarker or is it 3048?
[CUSTOMER][NEUTRAL] Yeah, that's the one with the B notice mhm.
[AGENT][NEUTRAL] OK, yeah, that's it.
[CUSTOMER][NEUTRAL] I see if you know that's HCA Florida University, right?
[AGENT][NEUTRAL] I think
[AGENT][NEUTRAL] Yes, the other one I have is the original. All right.
[AGENT][NEUTRAL] Because they sent it in and we asked for the explanation of benefits and then this one here is the 2nd 1.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm just gonna.
[CUSTOMER][NEUTRAL] Take that 10 down and.
[CUSTOMER][NEUTRAL] And the patient information's been verified right, [PII]?
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] OK, OK, you can send her on through and I'll see if I can.
[CUSTOMER][NEUTRAL] Assist her further
[AGENT][POSITIVE] Enlighten
[AGENT][POSITIVE] All right. Thanks, [PII]. Have a good day.
[CUSTOMER][POSITIVE] You too [PII] thank you.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] Hello, [PII].
[AGENT][POSITIVE] Thank you so much for holding. I have [PII] on the line and she'll be assisting you further, OK?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, go ahead.
[CUSTOMER][NEUTRAL] Hi [PII].
[CUSTOMER][NEUTRAL] Hey can you hear me OK?