AccountId: 011433970860
ContactId: 302b58ae-5b12-4938-8b7f-dbebcc880150
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 485850 ms
Total Talk Time (AGENT): 96864 ms
Total Talk Time (CUSTOMER): 145626 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/302b58ae-5b12-4938-8b7f-dbebcc880150_20250220T18:54_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]. Good afternoon. My name is [PII] and I'm calling you from the provider's office. And I'm looking for a claim status. And your first name is?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Uh, thank you so much, [PII].
[AGENT][NEUTRAL] And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Callback number is [PII]. It's a direct line. There's no extension.
[AGENT][POSITIVE] Thank
[AGENT][NEUTRAL] Thank you, sir, and then I can help you with the claim status. Can you please give me the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK. So the policy number, which is 01912872.
[CUSTOMER][NEUTRAL] That's what they did.
[CUSTOMER][NEUTRAL] And this patient name is [PII].
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK. And then what is the date of service, please?
[CUSTOMER][NEUTRAL] Mhm. Your service is [PII] I'm sorry, [PII] [PII]. And the charge amount is $1,347 even.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, I have to pull this information. Give me one moment. So the remaining balance you're talking about, right?
[AGENT][NEUTRAL] Yes, sorry.
[AGENT][NEUTRAL] Right, the charge amount after the primary insurance paid their part.
[CUSTOMER][NEUTRAL] OK, so the balance is give me one moment.
[CUSTOMER][NEUTRAL] Uh, [PII] us and us.
[CUSTOMER][NEUTRAL] 12. OK, it's 277.62.
[AGENT][NEUTRAL] Thank you. And then one last question, [PII], what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] It's on the South Florida Surgical Specialist LLC.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I pull up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] Mhm sure.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], looking at data service of [PII], I am not finding a claim on file for the amount that you have given.
[CUSTOMER][NEUTRAL] OK. I can give you the claim number.
[AGENT][NEUTRAL] OK, what is that please?
[CUSTOMER][NEUTRAL] 354-767-0
[CUSTOMER][NEUTRAL] 59
[AGENT][NEUTRAL] OK, let me see if I can find that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You the one
[CUSTOMER][NEUTRAL] You know
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] OK, so looking at this claim for you [PII].
[AGENT][NEUTRAL] The inpatient benefit amount for this calendar year was met and the claim was denied.
[CUSTOMER][NEUTRAL] So how much is the allowed amount for inpatient?
[CUSTOMER][NEUTRAL] Sorry,
[AGENT][NEUTRAL] $1000.
[CUSTOMER][NEUTRAL] And when it was made,
[AGENT][NEUTRAL] Yes, it was met for the calendar year.
[CUSTOMER][NEUTRAL] But what did the service it was met.
[AGENT][NEUTRAL] I can't give you that data service because it's not the provider that you are with.
[CUSTOMER][NEUTRAL] So this one's for different facility or provider?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So you want to say that for [PII] uh because we have built for the month of January when the start of the year.
[CUSTOMER][NEUTRAL] So some provider was billed before our claim?
[AGENT][NEUTRAL] Right, the, the amount for the calendar year was maxed out.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I do have a date when it was uh completed. I'm not asking for the provider information.
[AGENT][NEUTRAL] Mm I can't give that information it's private, but the amount for the calendar year was maxed out.
[CUSTOMER][NEUTRAL] I just
[CUSTOMER][NEUTRAL] OK, do you have the information for date of service? I'm not asking for the claim information for the provider. I'm just asking for date of service only.
[AGENT][NEUTRAL] I can't give that information. That's private information.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] OK, sounds good. Thank you so much for this information, [PII], and can I get the reference number of this call?
[AGENT][NEUTRAL] Yes, sir. You can use my name and today's date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much for your help and assistance and have a wonderful day ahead bye bye. Take care.
[AGENT][POSITIVE] You too. Thank you. You take care. Thanks for calling APL.
[CUSTOMER][NEUTRAL] Mhm. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] It.