AccountId: 011433970860
ContactId: 2632c8df-406a-4604-a953-484e96a2b5d9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 869619 ms
Total Talk Time (AGENT): 265491 ms
Total Talk Time (CUSTOMER): 308587 ms
Interruptions: 8
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/2632c8df-406a-4604-a953-484e96a2b5d9_20250110T16:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII] calling from the provider's office. I needed to check on claim status.
[AGENT][NEUTRAL] Hi [PII], I can help you with claim status. Can you please give me your callback number, sir, just in case the call is dropped.
[CUSTOMER][NEUTRAL] It is [PII]. It's a direct line.
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Patient's first name is [PII].
[CUSTOMER][NEUTRAL] It's [PII] Last name is [PII]. It's [PII], sorry, I'll repeat the last name. It's [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what is um Ms. [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And her policy number, please?
[CUSTOMER][NEUTRAL] I have a 21931.
[AGENT][NEUTRAL] OK, that's not a good policy number that sounds more like a group number do you have her policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, no, I don't have it. I need to check it.
[AGENT][NEUTRAL] OK, let me see if I.
[CUSTOMER][NEUTRAL] Did you find the patient with the name and date of birth? OK.
[AGENT][NEUTRAL] Yes, let me look and see if she's in here with the name.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] In
[AGENT][NEUTRAL] OK, let me make sure I've got her last name spelled correct. It's [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm not pulling in an insured with that name in our system.
[CUSTOMER][NEUTRAL] Uh, did you say, uh, [PII], right? [PII] Papa, right?
[AGENT][NEUTRAL] Oh, no, I said [PII] as [PII], or B as in boy. Let me try it with a P. SEP.
[CUSTOMER][NEUTRAL] Oh, OK, OK. Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh, there she is. I found her.
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] OK, uh, and then what is the data services?
[CUSTOMER][NEUTRAL] It is [PII] and the charge amount is $358 358 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look something up here real quick.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] It is $298.
[AGENT][NEUTRAL] OK and then what is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Uh, it is Palm Beach General Surgery.
[AGENT][NEUTRAL] OK, [PII], I'm gonna put you on a brief hold while I pull this claim in for us and I'll be right back.
[CUSTOMER][NEUTRAL] Sure. OK. You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me [PII]. So looking on data service of [PII], I do not find the claim on file.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] There's no claim on file.
[CUSTOMER][NEUTRAL] Could you help me with the claim mailing address and the PR ID?
[AGENT][NEUTRAL] Yes sir, the payer ID is 60801.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claims address is APL Claims.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's [PII].
[AGENT][NEUTRAL] That's in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And how, how, what is the time finding limit?
[AGENT][NEUTRAL] There's not one.
[CUSTOMER][NEUTRAL] So I can build this claim, right?
[CUSTOMER][NEUTRAL] Again.
[AGENT][NEUTRAL] Uh, you can build the claim again, but the effective date of the policy is [PII], and the policy terminated on [PII].
[AGENT][NEUTRAL] So the claim is for [PII].
[CUSTOMER][NEUTRAL] Oh, could you
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it. Could you repeat the term date?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And there are no active claims on our sorry no active policies on file.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] No, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] Uh, OK, OK, OK. Sorry. Got it, got it.
[AGENT][NEUTRAL] That's OK. I just, yes sir.
[CUSTOMER][NEUTRAL] Uh, I, I, I have two more claims with me. Sorry, could you help me check the status for them as well?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK, what is the next one?
[CUSTOMER][NEUTRAL] Next policy ID is 01458725.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima.
[AGENT][NEUTRAL] OK, and what's the patient's name?
[CUSTOMER][NEUTRAL] Patient's first name is [PII], and last name is
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me pull that policy in real quick.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and then what is the date of service for [PII]?
[CUSTOMER][NEUTRAL] Uh, it is [PII]. Charge amount is $435 435 dollars even.
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] OK, and that was [PII]?
[CUSTOMER][POSITIVE] Yes. Correct.
[AGENT][NEUTRAL] OK, and then what is the charge charge amount after the primary paid their part?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] It is $293.56.
[AGENT][NEUTRAL] OK, and is it for the same facility?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, no, it's under a different facility.
[AGENT][NEUTRAL] OK, what's that facility name?
[CUSTOMER][NEUTRAL] It is Columbia Primary Care LLC.
[CUSTOMER][NEUTRAL] A combustions.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Again [PII], I'm gonna put you on a brief hold while I look that claim up for you. I'll be right back sir.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII]. I'm back with you. Uh, so looking for [PII] for data service of [PII], I do not find a claim on file.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Is she active for the date of service?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, great. Uh, should I start with the last one?
[AGENT][NEUTRAL] OK, what is the last one?
[CUSTOMER][NEUTRAL] Last one is member ID is 01568608 M [PII] in Mike [PII] in [PII].
[CUSTOMER][NEUTRAL] I I have it.
[AGENT][NEUTRAL] OK, and then what's the insured's name?
[CUSTOMER][NEUTRAL] That's [PII]. Date of birth is [PII], sorry, [PII].
[AGENT][POSITIVE] OK, thank you and let me pull that policy in real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and then what is the date of service for, [PII]?
[CUSTOMER][NEUTRAL] It is [PII]. Charge amount is 500 $153 153 dollars even.
[AGENT][NEUTRAL] OK, and then the amount after the primary paid their part?
[CUSTOMER][NEUTRAL] $75.
[AGENT][NEUTRAL] OK, and then what is the name of the facility please?
[CUSTOMER][NEUTRAL] It is Palm Beach Generals LLC Surgery LLC.
[AGENT][NEUTRAL] OK, I'll put you on a hold real quick, [PII]. I'll be right back.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you again so I did find this claim.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim number is 352.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0695.
[AGENT][NEUTRAL] The claim was denied.
[AGENT][NEUTRAL] Because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Um not covered.
[CUSTOMER][NEUTRAL] Mm. When was this claim received and denied?
[AGENT][NEUTRAL] It it was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] OK. Is there any other insurance with the patient?
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. It was really nice speaking to you. Could you help me with the reference number for this call?
[AGENT][NEUTRAL] Yes sir, you can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. It was nice speaking to you. Have a great rest of your day and happy weekend.
[AGENT][POSITIVE] Thank you, [PII]. You have a blessed weekend too, and thanks for calling APL, sir.
[CUSTOMER][NEUTRAL] Yeah. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Yeah.