AccountId: 011433970860
ContactId: 32343279-d5d6-428f-86ee-e0eafa48cb09
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 272010 ms
Total Talk Time (AGENT): 117916 ms
Total Talk Time (CUSTOMER): 92952 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/32343279-d5d6-428f-86ee-e0eafa48cb09_20250521T13:31_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling for Bora's office to check on a claim status.
[AGENT][NEUTRAL] OK, I can verify claim status and, and what is the policy number, please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's going to be 01935548 M as in Mike, L as in Lima, number 8. You said your name is [PII]?
[AGENT][NEUTRAL] Yes ma'am, [PII] last initial [PII] and Ms. [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII] with the extension of [PII].
[AGENT][POSITIVE] OK, thank you, give me one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment please.
[AGENT][NEUTRAL] And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] It's going to be [PII] The last name is [PII] The date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you so much and what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] It's going to be [PII] with the amount of $421 even.
[AGENT][NEUTRAL] OK, thank you and do you have the balance after primary insurance has processed the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's 124.87.
[AGENT][NEUTRAL] OK, thank you so much and you're calling from or the name of the provider's office is?
[CUSTOMER][NEUTRAL] University of Miami Medicine.
[AGENT][NEUTRAL] And you said the total charge amount was $431?
[CUSTOMER][NEUTRAL] $421.21.
[AGENT][NEUTRAL] 21, thank you one moment and while I'm looking up claim information just to let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at secured. [PII].
[CUSTOMER][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I show that claim process as the outpatient benefit has maxed for the calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Benefit maximum has been reached.
[AGENT][NEUTRAL] Uh, correct, for the calendar year for outpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, it's a dollar value of the visit?
[AGENT][POSITIVE] Dollar value
[CUSTOMER][NEUTRAL] May I know the dollar value amount, total amount?
[AGENT][NEUTRAL] Uh, the insurer has an outpatient benefit max of up to $7350 and they've met that max for the year.
[CUSTOMER][NEGATIVE] I'm uh totally mad, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And it's a member responsibility?
[AGENT][NEUTRAL] Uh, we can't give patient responsibility. We can only verify how the claim was processed.
[CUSTOMER][NEUTRAL] OK, may I know the claim number?
[AGENT][NEUTRAL] 356-070-2
[CUSTOMER][NEUTRAL] OK. And may I know the date for this one?
[AGENT][NEUTRAL] Claim received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] OK and uh can you provide the UB copy to the fax number? Shall I provide the fax number for you?
[AGENT][NEUTRAL] Sure, give me one moment, please.
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] It's going to be [PII].
[CUSTOMER][NEUTRAL] With the attention of my name, it's [PII].
[AGENT][NEUTRAL] OK, and you said the fax number is [PII], is that correct?
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah.
[AGENT][NEUTRAL] OK, and is there anything else I can assist you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] No, may I know the time when will you receive that by end of the day?
[AGENT][NEUTRAL] Uh, hopefully in a few moments.
[CUSTOMER][NEUTRAL] Oh, OK, thank you for that. And may I know the call for this called [PII].
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name in today's date.
[CUSTOMER][POSITIVE] OK, OK. Thank you for that information and thank you for helping me today. Bye-bye. Take care.
[AGENT][POSITIVE] You're welcome thank you for calling APL bye.
[CUSTOMER][NEUTRAL] Bye bye.