AccountId: 011433970860
ContactId: 2e3dbaa2-1c65-4396-bb41-0da0a0ab2d55
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 854619 ms
Total Talk Time (AGENT): 236545 ms
Total Talk Time (CUSTOMER): 378541 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/2e3dbaa2-1c65-4396-bb41-0da0a0ab2d55_20250611T14:08_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. One moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I'm sorry. Hi, good morning. I'm sorry. This is [PII] from Baptist Hospital of Miami. I wanted to check. Um, I have like 5 days of service on this one patient, please.
[AGENT][NEUTRAL] OK, well, I can help you with the claim status. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] Thank you for that. May I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes. Um, where am I right here? OK. So this number is 2, I'm sorry, 02337124.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's um.
[CUSTOMER][NEUTRAL] Uh, [PII], uh 5-1769.
[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 all the dates of service and the total bill?
[CUSTOMER][NEUTRAL] Yes, on this one, the first one is [PII].
[CUSTOMER][NEUTRAL] And that amount that was billed was for $796.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, you need all of them. I'm sorry. OK. One second. It's the, it's the same patient, yeah. And then the other one.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The other one is
[CUSTOMER][NEUTRAL] The other one is, one second. So um uh [PII].
[CUSTOMER][NEUTRAL] To go through each 1 [PII], this one here.
[CUSTOMER][NEUTRAL] And that amount is for um
[CUSTOMER][NEUTRAL] 2, I'm sorry.
[CUSTOMER][NEUTRAL] 21,211.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then the other one is um um [PII].
[CUSTOMER][NEUTRAL] And um let me go up here, this one here. [PII] is for uh 796.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um [PII].
[CUSTOMER][NEUTRAL] [PII] and that [PII], and that is for um
[CUSTOMER][NEUTRAL] Um 8, I'm sorry, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the last one is [PII].
[CUSTOMER][NEUTRAL] [PII], wait a minute, wait a minute, what happened here?
[CUSTOMER][NEUTRAL] [PII], no, that's paid.
[CUSTOMER][NEUTRAL] [PII], this one year.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, that's not it.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I'm sorry, one second. No, I think that's it. So why do I have this on my thing?
[CUSTOMER][NEUTRAL] That's it. I'm sorry. Um, that's it.
[AGENT][NEUTRAL] It's OK. Um, so there, so there isn't one for [PII]?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, I'm trying to look again. Where did I get that? One second, let me know how can I.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][NEGATIVE] Jeez
[CUSTOMER][NEUTRAL] Um, no, it's uh, let me see.
[CUSTOMER][NEUTRAL] 197. What date is that?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] Mm. No, that's it. I, I don't know, something is not right with my work list here.
[AGENT][NEUTRAL] OK, um, hold on one moment.
[CUSTOMER][POSITIVE] That's it, sweetie. I'm so sorry. I'm so sorry for that.
[AGENT][NEUTRAL] No, you're fine. Hold on one moment, let me look this up.
[AGENT][NEUTRAL] And is it alright if I place you on just a brief hold?
[CUSTOMER][POSITIVE] Sure, sure, sure. Take your time. Thank you.
[AGENT][NEUTRAL] OK, hold on one moment. You're welcome.
[CUSTOMER][NEUTRAL] Mm. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] 419.
[AGENT][NEUTRAL] 1992.
[AGENT][NEUTRAL] 587 all around.
[AGENT][NEUTRAL] Wait, wait, wait, wait. I almost got caught up. Let me make sure these are the correct total bill. Well, that's a given.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Those, I think are the same.
[AGENT][NEUTRAL] This 21,000, I wanted to check because it didn't show that.
[AGENT][POSITIVE] Alright, cool.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] And 8000, the 796, I'm for sure.
[AGENT][NEUTRAL] Um and that one is.
[AGENT][POSITIVE] I think I saw it already. OK, cool.
[AGENT][POSITIVE] Alrighty then.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So the um first
[CUSTOMER][NEUTRAL] Yes, hi.
[CUSTOMER][POSITIVE] No, no problem.
[AGENT][NEUTRAL] So the first claim um for [PII], um, we received that claim on [PII].
[AGENT][NEUTRAL] The claim number is 359.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 1092.
[AGENT][NEUTRAL] On [PII], the claim was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because the outpatient benefit for this cal calendar has been met.
[CUSTOMER][NEUTRAL] Benefit Max. And this is for the um the [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, perfect. Thank you.
[AGENT][NEUTRAL] You're welcome. The next one is [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That claim was received on [PII]?
[AGENT][NEUTRAL] And the claim number is 35865887.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], we paid out on that claim to the provider.
[AGENT][NEUTRAL] A total of $930.90.
[CUSTOMER][NEUTRAL] OK. So, let me ask you on that payment. I'm sorry, I'm so sorry. Go ahead. Oh, I received the payment. Um, so that's what I see here. So that 930, I think I'm gonna need the EOB because they, is that, um, let me go back to that 1 [PII]. So the, the, the 9:30, they must have put, they must have put it on one claim because I'm showing where.
[AGENT][NEUTRAL] Did you need the um checking.
[CUSTOMER][NEUTRAL] OK, was it 9:30 for 2 for more than one claim, or was it, why did you pay? Because I was looking on.
[AGENT][NEUTRAL] No, it's just this one claim.
[CUSTOMER][NEUTRAL] OK, well, you must have overpaid because the the the amount of the claim.
[CUSTOMER][NEUTRAL] Oh, I know what happened. It must be a corrected claim. That's what it is.
[CUSTOMER][NEUTRAL] OK, OK, OK. I think that will happen. Yeah, we owe you money.
[CUSTOMER][NEUTRAL] Yeah, I just realized this is the correct claim. What are the charges? You know what is it? I'm talking to [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hi [PII], I'm so sorry it's crazy this morning. Um, what is the amount of the claim that you have that you paid at $930 on?
[AGENT][NEUTRAL] The total bill was the $21,211 but we were charged 18 or I'm sorry.
[AGENT][NEUTRAL] $1880.46 and all they had left of their um outpatient max was $930.90. We applied it all to this balance.
[CUSTOMER][NEUTRAL] And how much you said you were charged? The the claim was 21,211, right?
[AGENT][NEUTRAL] Right, that was the total bill.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] But uh we were charged $1880.46.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I don't see that we charge you that.
[AGENT][NEUTRAL] Like how much was billed to us.
[CUSTOMER][NEUTRAL] OK, I'm gonna have to look at that. Um, I'm gonna have to look. It looks to me like we have to give you back some money because, um, I'm showing that we were supposed to get 200 and actually one second.
[CUSTOMER][NEGATIVE] Oh boy, what a mess. OK, I'm sure I'm showing that we're supposed to get.
[CUSTOMER][NEUTRAL] I'm gonna have to look at this claim 600 and.
[CUSTOMER][NEUTRAL] $58 8865834 and you paid $930 so we're gonna have to look at this thing. We might have to give you back some money. I, I don't know what happened, so I'm just gonna leave that aside. So, OK, whenever you're done, we'll go to the other one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so the next claim, um, [PII].
[AGENT][NEUTRAL] We received that claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 1916.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], um, the claim was denied because the outpatient max was met for the calendar year.
[CUSTOMER][POSITIVE] OK. Outpatient Max. OK, Max, no problem. All right, perfect. And then do I have another one? Mhm.
[AGENT][NEUTRAL] And then the last one, for [PII], we received it on [PII].
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And that claim number is 3591936.
[CUSTOMER][NEUTRAL] Cha
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] And on [PII], this claim was also denied?
[AGENT][NEUTRAL] Because the calendar year max has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Um, perfect.
[CUSTOMER][POSITIVE] All right, um, great. I thank you so much. I appreciate your help today. I really do want your patience with us. Um, so that, that other one we might have to send you back some monies because of, uh, I have to pull the EOBs and then I will, um, I will, you know, um, send it over back to you guys. What's, what's your um email again? Secure, is it secure? What's the email for claims?
[AGENT][NEUTRAL] Our email is
[AGENT][NEUTRAL] Uh, there's no claims email. You can't, we can't receive claims through email. Um, the emails for the what what are you trying to send over?
[CUSTOMER][NEUTRAL] I'm going to send you over the EOB and and um and tell you that I'm gonna be um sending back some monies or something on there.
[AGENT][NEUTRAL] Um, so that wouldn't be sent through, um, email that it'll be just how you send a claim. You can fax it, you can mail, you can send it to us electronically.
[CUSTOMER][POSITIVE] OK. All right, great. Thank you so much. I appreciate it. Have a great day, [PII]. Take care. Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] You also, [PII], and my name.
[AGENT][POSITIVE] Have a good day thanks for calling APL bye bye.
[CUSTOMER][POSITIVE] And I thank you, thank you so much. Bye-bye. Bye-bye.