AccountId: 011433970860
ContactId: 31265f65-0fc0-4f6c-9659-ffccd6016ed1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 547900 ms
Total Talk Time (AGENT): 203532 ms
Total Talk Time (CUSTOMER): 413712 ms
Interruptions: 15
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/31265f65-0fc0-4f6c-9659-ffccd6016ed1_20250519T18:04_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Oh, hi, [PII]. Good afternoon. How are you today?
[AGENT][POSITIVE] I'm good. How about you?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Good, thank you. This is [PII] calling from Baptist Hospital of Miami, the Miami Cancer Institute. I have a question. Um, can you check for me, they just sent me an email if this member.
[AGENT][NEUTRAL] OK, yes.
[CUSTOMER][NEUTRAL] is still covered with you guys cause um I'm looking at they're telling me the claim was paid. There were some claims, but this is for [PII]. I just wanna make sure. Can you check if the patient still has coverage with you guys?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK. Yeah.
[AGENT][NEUTRAL] Yes, Ms. [PII], I can. Um, what is the policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, sure. Let me find it. One second. Let me see that she sent it to me.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Evidently, the patient must have called in. Let me just see.
[CUSTOMER][NEUTRAL] Looking for APL. They say APL paid on [PII] claim, so they wanna know, let's see, APL.
[CUSTOMER][NEUTRAL] American Public. Where are you guys? OK. No, that's WebTP. No, that's not you.
[CUSTOMER][NEUTRAL] Where is it? Oh, here it is. OK. Here is the number that I see. C as in Charlie. This doesn't sound like you guys though. Anyway, C as in Charlie, 02137550. Is that yours?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Let me try without the seat and see if I pull anything. OK.
[CUSTOMER][NEUTRAL] OK, OK, OK. Yeah. OK. 021, yeah, it looks strange. 02137550.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] That's so more like you guys. I don't know where they get this number from.
[AGENT][NEUTRAL] Mm, um, what's the name of the patient?
[CUSTOMER][NEUTRAL] Ah.
[CUSTOMER][NEUTRAL] Sure, sure, sure. The name is um [PII]. Uh date of birth [PII].
[AGENT][NEUTRAL] OK, yeah, that is the policy number. You just need to take that C out. I'm not sure where they got that C from.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That's, I know, exactly.
[CUSTOMER][NEUTRAL] Exactly, just when I pulled it up, wait a minute here. I know, I know you guys, I know you guys' numbers. I'm like, wow, when I see that C.
[CUSTOMER][NEUTRAL] That could be the problem so I'm taking it out right now, so right now, OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And let's see um.
[CUSTOMER][NEUTRAL] Take it out and see. Maybe that's why. OK, right. Mhm.
[AGENT][NEUTRAL] Mhm. Let me have a callback number just in case we get disconnected. I didn't get that.
[CUSTOMER][NEUTRAL] Sure, sure, sure, sure. It's uh [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. All right, so we have an effective date of [PII] and it terminated [PII] under this policy. You said the date of service was [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, yes, let me go back to their email. One second. Let me go back. What did she say? Here, here it is. Patients, uh, need assistance in APL. We can we build APL before for the for the service.
[AGENT][NEUTRAL] Um, what's your service.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, what is that? [PII]. Yeah, [PII]. Are you covered that time? Yes, you should, right?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah, mhm. And that's, is that the date of service? Mhm.
[CUSTOMER][NEUTRAL] You did? OK.
[CUSTOMER][NEUTRAL] Yes, [PII], so that's what they, they, um, given me here. Yes, the claim is [PII]:30 2023 and we build United, so um it's OK for you to, we can bill you for the 118572 patient got a bill and they called in.
[AGENT][NEUTRAL] November.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm, it looks like that's the remaining. Mhm. It sounds like that's the remaining. Let me pull the EOB because it looks like we paid on what they have left from their major, um, I'm sorry, what they have left from the maximum benefit of the policy and there was a balance left. So let me check on and see if that's the case on this one, OK?
[CUSTOMER][NEUTRAL] So you want me to check and I just want to double check.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So did you, did you you didn't receive this claim because we didn't bill it to you, did we?
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] I'm not sure. I have one here. Um, I'm, I'm gonna pull this one. I do see a a charge here. Was it for the facility?
[CUSTOMER][NEUTRAL] We didn't bill you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For, for Bap, it will be on the Baptist Hospital of Miami.
[AGENT][NEUTRAL] OK, let, let me try this one.
[CUSTOMER][NEUTRAL] It will say Baptist Hospital.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Or baptist.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] So effective date let me see.
[CUSTOMER][NEUTRAL] [PII] terminated.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Mm, OK. Uh, what is, is that the total charge, the, the amount that you gave me is the total charge or that was just the difference? OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No, no, the, the total charge, no, no, the total, the total charge was, um, one second, let me just get out of here.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, um.
[CUSTOMER][NEUTRAL] Let me just get out here. Um, um, um, the total charge is one second, so it's just taking forever to get out. The total charge for this, for the claim is, um, come on.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Just give me a chance to get out of here. OK. Is it 5,107, um, United paid 121,620. They, the patient got billed. Hm, I did 1085, 121,620.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Huh.
[AGENT][NEUTRAL] really.
[CUSTOMER][NEUTRAL] Yeah, we billed, we billed her and she paid the $30. Yes, that's what we're getting 1185. Yeah. So the total bill, the, the original bill amount 5,107. Mhm.
[AGENT][NEUTRAL] 117, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, you may let me pull this other claim. She does have some claims here that were denied for that day, so I'm just trying to make sure that you don't have, yeah, just in case. Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, really?
[CUSTOMER][NEUTRAL] Because I'm looking at unless it's from different providers because I'm looking at at this claim we never billed you it was dropped to her I guess she got the bill.
[AGENT][NEUTRAL] Never, oh.
[AGENT][NEUTRAL] Oh, OK, OK, if you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] We never mailed you. We never will you.
[AGENT][NEUTRAL] OK. OK, so yeah, you can go ahead and submit the claim.
[CUSTOMER][NEUTRAL] Because we didn't have you guys on there. I don't know what happened. They didn't have you checked the secondary, so she got the bill and um.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] She started paying on it and then what is this one saying that signa that's not mine. So then, um, let me just look at her account. That's what it that's uh signa. Anyway, let me see if we billed you for this one. Hold on. 2020, wait a minute. Oh no, she has a different insurance. She has web TPA wait a minute for [PII].
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, uh, uh, well, yeah, you're right, because you weren't, you weren't, that one is also terminated. What is this? You said she was terminated with you 11724. OK, so she, I saw another ins insurance, yeah. You're correct. Yeah, you're correct, cause I saw another insurance, Transamerica, for [PII], a secondary, but they, they're saying a note here that this was also terminated, so I don't know.
[AGENT][NEUTRAL] 24, yes, yeah, so during that time, yeah.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I'm not gonna worry about that one. So you're uh can I bill you for the um.
[CUSTOMER][NEUTRAL] The what they
[CUSTOMER][NEGATIVE] Oh my God, I'm so messed up today. The [PII]? OK.
[AGENT][NEUTRAL] You can, for the date of service, [PII], you can build, uh, we cannot guarantee that it's gonna be paid, it doesn't look like it, but yeah, you can be, so you can have a EOB.
[CUSTOMER][NEUTRAL] Yeah, yes. OK.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Perfect. Yeah, I have an EOB at least I'll try to find. Let me do that. So let me, let me get the EOB and then let me pull, and let me um get this. I have to, uh, manually do a request of claim, so I have to wait first before I get a claim form. So it's gonna take me like another day because the system doesn't generate it right away. So I have to get a claim for you American public, and then I'll send them both over to you guys. So I just wanted to make sure. OK, perfect, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Mm, got you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, no problem. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] OK, then we'll see what happens. No, ma'am, that's it. Thank you guys as usual for your quick response.
[AGENT][NEUTRAL] Hm
[AGENT][POSITIVE] You're welcome. No problem. You have a good day, Miss [PII]. You're welcome.
[CUSTOMER][POSITIVE] I appreciate it so.
[CUSTOMER][POSITIVE] Yes, you have a great day. You too, [PII]. Take care.
[AGENT][POSITIVE] Thank you. You too. Bye bye. You're welcome.
[CUSTOMER][NEUTRAL] OK, thank you. Mhm. OK, bye-bye. Bye-bye.