AccountId: 011433970860
ContactId: 2ec577d1-516f-41a2-9630-c27728635c3f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 571169 ms
Total Talk Time (AGENT): 227260 ms
Total Talk Time (CUSTOMER): 176071 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/2ec577d1-516f-41a2-9630-c27728635c3f_20250513T18:46_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, calling for claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you and your name is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] The Policy number is 025799973.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And do you
[CUSTOMER][NEUTRAL] And then there's a like a ML 8 on the end of it.
[AGENT][NEUTRAL] Oh, that's fine. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]. My extension is [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] The patient is [PII]. Her date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] I got 3 dates. The first is [PII], build them out 328.
[AGENT][NEUTRAL] OK, and what is the next date?
[CUSTOMER][NEUTRAL] Please, where do you wanna
[CUSTOMER][NEUTRAL] [PII], the bill amount is 290.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] and we also have [PII] for 328 and [PII] for 328, so it's 4 total.
[AGENT][NEUTRAL] 328. OK, thank you. Give me one moment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh, for each one, do you have the balance after primary?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For [PII], the balance is 55. [PII], 55, [PII], 55, and [PII] is also 55.
[AGENT][POSITIVE] Oh, that's easy enough. Awesome thank you ma'am. Give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What's your name?
[AGENT][NEUTRAL] [PII], last initial [PII]
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] 25.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Patient asking to speak with you.
[AGENT][NEUTRAL] 602.
[AGENT][NEUTRAL] Oh, that does not
[CUSTOMER][NEUTRAL] For
[AGENT][NEUTRAL] 00 OK 440.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Calling and I was trying to
[AGENT][NEUTRAL] And you're calling from uh Ms. [PII]?
[CUSTOMER][NEUTRAL] Orthopedic Center of South Florida.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you're with
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, uh, it shows that each one of those claims were received, um.
[AGENT][NEUTRAL] For the [PII], um.
[AGENT][NEUTRAL] This one processed as benefits payable only as primary pays, but the other three days I do show um claims were processed and paid at $55.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, I need a little more information like the claim number, the payment date.
[AGENT][NEUTRAL] OK, and get.
[CUSTOMER][NEUTRAL] So I'm sorry, you said the 42?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Medicare, not Medicare, the primary Florida Blue applied $55 to the co-pay.
[AGENT][NEUTRAL] Uh, let me look.
[CUSTOMER][NEUTRAL] For that for 2 data service.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, and that's on the EOB.
[AGENT][NEUTRAL] Let me see, give me one moment.
[CUSTOMER][NEUTRAL] Everything.
[CUSTOMER][NEUTRAL] Now you get you can tell them they got reduced because of the today's payment they got reduced to 134.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, if you can send that EOB to us because I see we received an EOB, but it doesn't show anything towards deductible, co-pay or co-insurance, and it doesn't show a patient responsibility.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It, it, it shows it um if you look down to the left bottom you'll see it's there it's if I send it again it's gonna be the same EOB.
[AGENT][NEUTRAL] Um, looking at that you'll be receiving it's not on there, so if you can please send that to us so they can go back and review.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Ma'am, it's on there it's it's in the left hand corner towards the bottom it says copay and $55 next to it. Copay $55 patient responsibility.
[AGENT][NEUTRAL] Ma'am, and I
[AGENT][NEUTRAL] And I'm looking at what we received and it does not state that that's why I asked if you can submit what you have showing that it was applied and go back and reprocess, but what I'm looking at, I don't show any amounts towards deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Um, what's the fax number, Kiki?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 942-3 and when was it received?
[AGENT][NEUTRAL] Uh, this claim was received on, give me a moment.
[AGENT][NEUTRAL] On [PII], process on [PII].
[CUSTOMER][NEUTRAL] What's that claim number?
[AGENT][NEUTRAL] 3600258
[CUSTOMER][NEGATIVE] And they should be faxed to attention claims.
[AGENT][NEUTRAL] Uh, claims department, yes ma'am.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And what was the outcome of the other dates? I'm sorry.
[AGENT][NEUTRAL] Uh, the other dates that do show they were claims they were paid, um.
[CUSTOMER][NEUTRAL] OK, can I have the receipt and process date for all?
[AGENT][POSITIVE] Thank
[AGENT][NEUTRAL] Yes ma'am, give me one moment while I get this.
[AGENT][NEUTRAL] Uh, looks like those were all received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The for
[AGENT][NEUTRAL] I'll give you the check information or the check number when you're ready.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, for the [PII], the check number is 2043921.
[AGENT][NEUTRAL] For the for 7 days, go ahead, sorry.
[CUSTOMER][NEUTRAL] Just uh
[CUSTOMER][NEUTRAL] I need the claim number for the 44.
[AGENT][NEUTRAL] Um, 3600251.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, for the 47, that check number is 2043922.
[AGENT][NEUTRAL] And the claim number is 3600264.
[AGENT][NEUTRAL] And for the [PII], uh, that check number is 20, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] When was the, I'm sorry, when the 17 received and processed date?
[AGENT][NEUTRAL] It was received on [PII], processed on [PII]. All of them received on [PII]h and process, yes, ma'am.
[CUSTOMER][POSITIVE] OK, I love them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] OK, and the [PII], uh, that check number is 2043923.
[AGENT][NEUTRAL] And the claim number is 3600354.
[CUSTOMER][NEUTRAL] And was all these single payments OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, you get reference numbers for the call?
[AGENT][NEUTRAL] Uh, no, ma'am, but if you like, you may use my name and [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][POSITIVE] Thank you so much for your help. I really appreciate it.
[AGENT][POSITIVE] Oh, you're welcome. Uh, thank you for calling APL. Have a great day, Miss [PII].
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye.