AccountId: 011433970860
ContactId: 224e592e-a703-4922-ba06-f7c591024cb1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 722340 ms
Total Talk Time (AGENT): 274849 ms
Total Talk Time (CUSTOMER): 202674 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/224e592e-a703-4922-ba06-f7c591024cb1_20250320T17:41_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, sorry. My name is [PII], and I'm calling because I had submitted my secondary insurance to a hospital, and they still have the claim pending. They told me to call APL to see the status on why it hasn't been paid.
[AGENT][NEUTRAL] OK, Miss [PII], I can help you with your claim status. Uh, can you please give me your policy number?
[CUSTOMER][NEUTRAL] Sure, policy number is 01813054.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, Ms. [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, ma'am. And then I'm also going to need for you to verify your address, the phone number and email address that we have on the policy.
[CUSTOMER][NEUTRAL] OK, address is [PII].
[CUSTOMER][NEUTRAL] And email, not sure you have mine or my husband.
[CUSTOMER][NEUTRAL] Uh, mine is [PII]. His is [PII].
[AGENT][NEUTRAL] Thank you. And then the phone number that's on the policy?
[CUSTOMER][NEUTRAL] Um, it's his employer, so maybe it's his [PII].
[AGENT][POSITIVE] Yes ma'am, that's correct thank thank you very much and then if we get disconnected Miss [PII], what's a good number to call you back on?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you ma'am. OK, and do you know your claim number?
[CUSTOMER][NEUTRAL] Um, let's see. So I
[CUSTOMER][NEUTRAL] I don't think I have one for Nicholas Children's Hospital. They haven't, you haven't sent me any um information. I do have some other claims that I submitted recently, but not the one I'm looking for.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Can you um give me the name of the patient for the one that you're looking for?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, let me look real quick and see what we got for [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] So looking for [PII] on this policy, I don't show that the hospital has submitted anything to us. There's not a claim for [PII].
[CUSTOMER][NEUTRAL] There isn't one from um last year for, I think it was [PII].
[AGENT][NEUTRAL] I'm gonna look by date too, but right now, I'm not showing anything. So February.
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] Um, I have a, let's see, the statement date was [PII]. How about, OK, I see here date of service, [PII].
[AGENT][NEUTRAL] Yes, that's not been submitted to us and let me see if you have any other policies that it could have gone to.
[AGENT][NEUTRAL] I wanna double check everything.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] No, it would have gone, let's see, oh, this one probably. Let me see.
[AGENT][NEUTRAL] No, um, this is the most current policy and the effective date of this policy is [PII], and you said it was [PII], so that would have fallen in that date range.
[AGENT][NEUTRAL] No, ma'am. I'm not showing anything that's been submitted for Skyler.
[CUSTOMER][NEUTRAL] So the date of service was [PII].
[AGENT][NEUTRAL] [PII]. 0, OK. Let me see if I can find an old policy that it might be on there. Let me look.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, thanks.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] No ma'am, the previous policy I looked at it where it's effective date was [PII] and no claim for Skyler had been submitted on that one either.
[CUSTOMER][NEUTRAL] OK, OK. So then I'll call the hospital back and see what's going on because I know they submitted it twice, um, but I guess something's going wrong if you haven't received it, right?
[AGENT][NEUTRAL] Right, um, let me give you our payer ID number and just in case they'd like to submit it electronically.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, what's that?
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] 60801. OK, that's your payer ID. OK, great. And then I have another one I wanted to get the status on, please. This one is for um for me. It's under my name. It was a service I had done, so [PII], and it was with Aming Association, Greater Miami.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and is it gonna be under that policy number 3 that ends in 3054, is that correct?
[CUSTOMER][NEUTRAL] Correct, yes, and date of service [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me look on that, go back to that other policy real quick.
[AGENT][NEUTRAL] And what was the name of the facility?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Amos Association, Greater Miami.
[AGENT][NEUTRAL] OK, showing that you have uh [PII] claim that was paid to South Miami Cridicare.
[CUSTOMER][NEUTRAL] Um, yes, that should be the one.
[CUSTOMER][NEUTRAL] Um, well.
[AGENT][NEUTRAL] OK, good. All right. Let me look at this check number real quick.
[AGENT][NEUTRAL] OK, so on [PII].
[AGENT][NEUTRAL] We paid $358.94.
[AGENT][NEUTRAL] To South Miami Credi Care.
[AGENT][NEUTRAL] Uh, they cashed the check on [PII].
[CUSTOMER][NEUTRAL] OK, so they already have that.
[AGENT][NEUTRAL] Yes, they have that and they.
[CUSTOMER][POSITIVE] OK, perfect. So,
[AGENT][NEUTRAL] Already cashed that one.
[CUSTOMER][NEUTRAL] OK. So the one I'm looking for is Anastasia, sorry, Anesthesia Association, Greater Miami, and it's for $713.80.
[AGENT][NEUTRAL] OK, let me pull up.
[AGENT][NEUTRAL] Anything from [PII] and see what we have.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Do you know what the amount of that claim was?
[CUSTOMER][NEUTRAL] Yes, $713.80.
[AGENT][NEUTRAL] OK, let me write that down.
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] Here we go. I think I just found it.
[AGENT][NEUTRAL] OK, let me look this one up real quick.
[AGENT][NEUTRAL] OK, I'm also showing this was paid.
[AGENT][NEUTRAL] It was paid the full $713.80.
[AGENT][NEUTRAL] Let me pull up the check number real quick and see the status of that.
[CUSTOMER][NEUTRAL] that. OK.
[AGENT][NEUTRAL] This one was paid on [PII] and then.
[AGENT][NEUTRAL] $713.80.
[AGENT][NEUTRAL] It was paid to Ains Associate Greater Miami.
[AGENT][NEUTRAL] They have not cashed the check yet. um, let me give you that check number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] 2022.
[AGENT][NEUTRAL] 004.
[CUSTOMER][NEUTRAL] Let me repeat that. 2022004?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Great. Got it. Thank you. So I'll follow up with um the clinic and see why they haven't passed it. Yeah, cause I'm still waiting for that refund as well.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Great. Thank you so much for your help. Now, also call the, the the children's hospital and see um the
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] The status and give them the payer ID hopefully they can submit that claim soon.
[AGENT][NEUTRAL] Right, yes, ma'am, yes ma'am. OK, well, Miss [PII], is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] That's it. Thank you.
[AGENT][POSITIVE] OK, you're very welcome. I hope you have a wonderful day and thanks for calling APL.
[CUSTOMER][POSITIVE] Thanks you too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.