AccountId: 011433970860
ContactId: 328b37eb-014a-4a06-b5e1-93a4dc3a9627
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1149420 ms
Total Talk Time (AGENT): 249271 ms
Total Talk Time (CUSTOMER): 312580 ms
Interruptions: 6
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/328b37eb-014a-4a06-b5e1-93a4dc3a9627_20250130T22:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII], and what's your name? Can you repeat your name? I haven't heard your name.
[AGENT][NEUTRAL] Yes, my name is [PII]. What's your name?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] OK, thank you sir and um what is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you sir and how can I help you today?
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEGATIVE] Actually, I'm calling on a denied claim.
[AGENT][NEUTRAL] OK, what is the patient's name?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you. And then what is the policy number?
[CUSTOMER][NEUTRAL] 01935517.
[AGENT][NEUTRAL] OK, let me pull in the policy real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then what is the date of service of the claim?
[CUSTOMER][NEUTRAL] And then what is the name of service that the client.
[CUSTOMER][NEUTRAL] [PII] with the charged amount of $10,0024.79.
[AGENT][NEUTRAL] OK, let me repeat that was [PII]. Is that correct? For $10,0024.79?
[CUSTOMER][NEUTRAL] Correct $10,0024.
[CUSTOMER][POSITIVE] Yes, that's absolutely uh.
[AGENT][NEUTRAL] OK, and then what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Primary insurance take part.
[CUSTOMER][NEUTRAL] $2,621.04.
[AGENT][NEUTRAL] Oh, thank you, sir. And then what is the name of the facility that you're calling for?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Medical City [PII].
[AGENT][NEUTRAL] Medical, and what was the second part of the name? Medical?
[CUSTOMER][NEUTRAL] That and
[CUSTOMER][NEUTRAL] Medical City, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much. I'm gonna put you on a brief hold then while while I pull up this claim for you and I'll be right back.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] On a brief hold while I pull up this claim for you.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK Demo, I found the claim for you, but it's going to be on a different policy number than the policy number you gave me.
[AGENT][NEUTRAL] Are you there?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello? Yeah, yeah, yeah, yeah, yes, yes, yes. I'm online, just.
[AGENT][NEUTRAL] OK. Yes. Did you hear me say that it's a different policy number?
[CUSTOMER][POSITIVE] I enjoy myself. Yes, yes, yes, I, yes, yes, I've been hear you. I get mute on myself.
[AGENT][POSITIVE] OK, good.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yes, sir. OK, so the, the policy number is 226.
[CUSTOMER][NEUTRAL] OK, so the
[CUSTOMER][NEUTRAL] My number is
[AGENT][NEUTRAL] 7455.
[CUSTOMER][NEUTRAL] 226-745-5
[AGENT][NEUTRAL] And the claim number is 354.
[AGENT][NEUTRAL] 5885.
[CUSTOMER][NEUTRAL] 354 588558885. OK.
[AGENT][NEUTRAL] And the claim was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK. And when did you receive the claim and when did you denied the claim? May I know the claim?
[AGENT][NEUTRAL] Let me look for you.
[CUSTOMER][NEUTRAL] Received and processed 39.
[AGENT][NEUTRAL] Yes, sir. Let me, let me look that up for you. We received the claim on [PII].
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] And processed it on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] it on the [PII].
[CUSTOMER][NEUTRAL] OK. And do you have the fax number?
[AGENT][NEUTRAL] Yes, sir. It's [PII].
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] 365
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 365
[CUSTOMER][NEUTRAL] 943.
[CUSTOMER][NEUTRAL] And what's the timely filing limit for submitting that on my EOB?
[AGENT][NEUTRAL] We don't, we don't have one.
[CUSTOMER][NEUTRAL] We don't, we don't have.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, and um.
[CUSTOMER][NEUTRAL] OK [PII], and I do have another two claims. Can you please help me with that? Uh, and I, it is regarding the same denial, but uh.
[CUSTOMER][NEUTRAL] It is going for the different person.
[AGENT][NEUTRAL] No, I can help you with your claims. um, what's the new member's name? the other member's name?
[CUSTOMER][NEUTRAL] No, I can help you with the claim. Um, what's the new member's name?
[CUSTOMER][NEUTRAL] Yes, yes. Just, just a moment, one moment. I'll provide you the name of the number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the member's name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Pro
[CUSTOMER][NEUTRAL] And [PII]'s date of birth is.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah, one moment please.
[CUSTOMER][NEUTRAL] So is there a, uh, could you please confirm me that the call reference number is going to be the same or else it is going to be different for the different person?
[AGENT][NEUTRAL] Oh, it's, it's the same with all of them.
[CUSTOMER][POSITIVE] Oh, it's interesting
[CUSTOMER][NEUTRAL] Yeah, what's the call reference number?
[AGENT][NEUTRAL] It's my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] My name to the next day.
[CUSTOMER][NEUTRAL] Yes, OK, [PII].
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] And uh [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] OK and then what is [PII]'s policy number?
[CUSTOMER][NEUTRAL] What is
[CUSTOMER][NEUTRAL] Yeah, the, the policy number is.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, let me pull his policy up for us real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Uh, what is, uh, it's [PII].
[CUSTOMER][NEUTRAL] Uh, what is
[CUSTOMER][NEUTRAL] This
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Yes, yes, it's, yes, yes, it's [PII].
[AGENT][POSITIVE] OK, thank you so much. And then what is the date of service?
[CUSTOMER][NEUTRAL] And then what is the
[CUSTOMER][NEUTRAL] The data service is on [PII].
[AGENT][NEUTRAL] And then what is the charge amount?
[CUSTOMER][NEUTRAL] in charge of
[CUSTOMER][NEUTRAL] 18,000, you need the remaining amount or else you need the total charges?
[AGENT][NEUTRAL] I'll need both.
[CUSTOMER][NEUTRAL] Oh, it's the $18,928. The total charges and the remaining is $2,232.68.
[AGENT][NEUTRAL] Thank you and what is the name of the facility for this one?
[CUSTOMER][NEUTRAL] What's the name of the
[CUSTOMER][NEUTRAL] Florida Northwest Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look this one up. I'll be right back.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, doing well. I'm back um I've got this name for you.
[CUSTOMER][NEUTRAL] OK. And actually, uh, just, uh, just a moment. We have sent that you will be to the same fax number that you have been provided before me. So could you please check from your end if you have received that or not?
[AGENT][NEUTRAL] I can't see it. I'm not in the area, the department that I can see the facts.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So OK, that's OK. We'll send that.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yeah, please go ahead.
[AGENT][NEUTRAL] The next claim number is 352.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 4342.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And it was also denied for the same reason we need a copy of the EOB from the primary insurance.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] I do have the information. Can you please tell me the claim received and denied it?
[AGENT][NEUTRAL] Received on [PII] and denied on [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] and died on.
[CUSTOMER][NEUTRAL] Get to the same fax number, [PII].
[AGENT][NEUTRAL] Yes sir.
[AGENT][POSITIVE] Yes, sir. That's correct.
[CUSTOMER][POSITIVE] OK, thank you so much. I'm for the next, yes, I'm going for the next one.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, who is the next one?
[CUSTOMER][NEUTRAL] Yeah, the next member name is.
[CUSTOMER][NEUTRAL] It's [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, and what is the policy number?
[CUSTOMER][NEUTRAL] 02514350.
[AGENT][POSITIVE] Thank you. Let me pull that policy up for us now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and it's for [PII]?
[AGENT][NEUTRAL] OK, I see now.
[CUSTOMER][NEUTRAL] Yes, [PII] well.
[AGENT][NEUTRAL] OK, alright and then what is [PII]'s data service?
[CUSTOMER][NEUTRAL] And what is our
[CUSTOMER][NEUTRAL] A data service is on [PII] with the total charge numbers of $6,944.65.
[CUSTOMER][NEUTRAL] And the remaining charges are $1,167.26.
[AGENT][NEUTRAL] OK, thank you. And what is the name of the facility for this one?
[CUSTOMER][NEUTRAL] It's Saint Mark's Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold again. I'm gonna look it up. I'll be right back.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, please go ahead.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK I'm back with you again. I do have the uh claim number for this one now.
[CUSTOMER][NEUTRAL] back with you. I just have the.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] Yeah, one moment, please.
[AGENT][NEUTRAL] It's 354. OK, I'm sorry.
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] Yes, yes, just a second.
[CUSTOMER][NEUTRAL] Yeah, please go ahead.
[AGENT][NEGATIVE] It's 3542358 denied for the same reason.
[CUSTOMER][NEUTRAL] 543582.
[CUSTOMER][NEUTRAL] 354
[AGENT][NEUTRAL] Yes, 3542358.
[CUSTOMER][POSITIVE] 235. OK, thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah, the name for the same reason, OK.
[AGENT][NEUTRAL] Yeah, it's the same reason, um, let me see if I get the dates for you.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Hold on, let me look at this one again.
[CUSTOMER][POSITIVE] Yeah, that's OK, thank you so much for that. That's not a problem.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 251-435.
[CUSTOMER][POSITIVE] Hey, sorry, thank you so much for the information.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] You don't want the um.
[CUSTOMER][POSITIVE] Have a good day.
[AGENT][POSITIVE] You have a blessed day too and thank you so much for calling APL.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Yeah, thank you. Have a good day. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.