AccountId: 011433970860
ContactId: 33d55bc2-f6ec-44a6-830e-1eb3a0e49bb1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 734700 ms
Total Talk Time (AGENT): 319150 ms
Total Talk Time (CUSTOMER): 270082 ms
Interruptions: 5
Overall Sentiment: AGENT=0, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/33d55bc2-f6ec-44a6-830e-1eb3a0e49bb1_20241231T20:09_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII]. I'm calling on behalf of HA Florida University Hospital to check the medical claims.
[AGENT][NEUTRAL] OK, you're, you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] The callback number is [PII]. My extension. It's a direct call.
[AGENT][NEUTRAL] Thank you and how many claims do you have to check status?
[CUSTOMER][NEUTRAL] Mm, one second, I'm checking that one. I think so.
[AGENT][NEUTRAL] How many?
[CUSTOMER][NEUTRAL] Uh, this one and another one, I have only 22 accounts in the system.
[AGENT][NEUTRAL] Are they for different members or is it the same member with different dates of service?
[CUSTOMER][NEUTRAL] Oh, this is a different, uh, facility and different number.
[AGENT][NEUTRAL] Yes, I can help you with both of those, and [PII], you will use my name that I gave you along with today's date as your call reference number for each one and also any information that I provide for you today will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, may I know your name, please? Could you please spell your name, now?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] is the first letter. Mhm.
[CUSTOMER][NEUTRAL] Sorry, could you please uh repeat it?
[CUSTOMER][NEUTRAL] Sorry, could you please spell your name again, now? A little bit slowly.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Last initial is [PII], right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you so much, [PII]. Uh, like.
[AGENT][NEUTRAL] And what is the first
[CUSTOMER][NEUTRAL] Do you need any information for the number?
[AGENT][NEUTRAL] Policy number for the first patient.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. The policy number of the member is 02286180.
[CUSTOMER][NEUTRAL] M as in Mary.
[AGENT][NEUTRAL] Thank you. One moment. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is uh [PII]. Yes, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Date of birth of the number is that is [PII].
[AGENT][NEUTRAL] Thank you. The date of service and total bill amount.
[CUSTOMER][NEUTRAL] The of service is on [PII]. And the total bill amount is that $85,109.60.
[AGENT][NEUTRAL] OK, can you please repeat the amount?
[CUSTOMER][NEUTRAL] And I have a correspondence, sorry, I have.
[AGENT][NEUTRAL] OK, can you repeat the amount?
[CUSTOMER][NEUTRAL] 85,000.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK. $85,109. It's $109.
[AGENT][NEUTRAL] 0.60.
[CUSTOMER][NEUTRAL] 60 cents. It's 60 cents. Yes, you got pricing.
[AGENT][NEUTRAL] OK, one moment please.
[AGENT][NEUTRAL] And do you have the claim number? OK, so there is no claim on file for this member on this policy for date of service and you did say [PII].
[CUSTOMER][NEUTRAL] Have the claim
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, we do not have a claim on file for this.
[CUSTOMER][NEUTRAL] I have a few.
[CUSTOMER][NEUTRAL] Mhm. OK. We have received the UOB and it was denied for near the primary UOB and they have sent the primary UOB to your, your fax number that is uh
[AGENT][NEUTRAL] OK, there is no claim on.
[CUSTOMER][NEUTRAL] I have a correspondence.
[AGENT][NEUTRAL] Yes sir, but what is the claim number? Because there's no claim on file with APL for that [PII], is that correct? [PII]?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, I will provide, I will provide that. Could you please check with that or not.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, sir. What is the claim number?
[CUSTOMER][NEUTRAL] It's 349-429-5.
[AGENT][NEUTRAL] 349-4095. Is that correct?
[CUSTOMER][NEUTRAL] No, no, no, no, no, no. It's 349-429-5.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So the date of service that's on that claim number is [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] To [PII].
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEGATIVE] You gave me [PII] and there is no claim on file for that data service.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] So let me look at the.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] Mm, yes, but uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] So the claim.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] That the bill amount is the same, right? Uh, so, could you please tell me that information now? It's, uh, sorry, 462, [PII]. I'll check again. In another system, I got the correct date of service in your your form. Could you please provide me that information?
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We did receive an additional claim for this state of service.
[CUSTOMER][NEUTRAL] We did receive
[CUSTOMER][NEUTRAL] service
[AGENT][NEGATIVE] And the, the most recently received claim from the provider has been denied. Give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim was denied and with the remark stating.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The above reference claim appears to be a duplicate of previously submitted expenses. Benefit payment has been made to the insured.
[CUSTOMER][NEUTRAL] No, one second, I'm sitting at home.
[CUSTOMER][NEUTRAL] 341. Uh, we have another claim uh for the
[CUSTOMER][NEUTRAL] 349-4295.
[AGENT][NEUTRAL] Yes, sir. That one was denied for the EOB, but in the meantime, the claim was received from the insured with all of the complete information and the benefit payment has been issued to the insured.
[CUSTOMER][NEUTRAL] Yes, so that one was
[AGENT][NEUTRAL] The claim number now for yours that has that remark is 352.
[AGENT][NEUTRAL] 9450.
[CUSTOMER][NEUTRAL] Uh yes. Uh, it was denied for duplicate. And another one is found in my system that is stating that 349-4295.
[AGENT][NEUTRAL] Yes, sir, but in addition to it being a duplicate.
[AGENT][NEUTRAL] Mm, that was the initial claim.
[AGENT][NEUTRAL] That was received from the provider, did I, did we just
[CUSTOMER][NEUTRAL] Yes, I have a claim number.
[AGENT][NEUTRAL] Yes, sir, but you're not listening to everything that I'm saying, [PII]. We denied that needing the primary EOB.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Before that was submitted to us, the insured filed a complete claim for the same data service and the benefit was made to the insured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Benefit payment was paid to the insured. Then we received.
[AGENT][NEUTRAL] Your claim again, and it was denied stating that it would appears to be a duplicate of previously submitted expenses benefit payment has been made to the insured.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Insured. OK. May I know the uh claim received date?
[AGENT][NEUTRAL] And the, uh-huh, and the claim number that that.
[AGENT][NEUTRAL] Yes, this claim remark.
[CUSTOMER][NEUTRAL] Yes, this
[AGENT][NEUTRAL] Is on claim number 352-9450.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] And that claim was received on [PII] and processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] May I know the original claim that is received on, uh, which one is 3.
[CUSTOMER][NEUTRAL] 494295
[AGENT][NEUTRAL] That claim was denied needing the primary EOB when the information was submitted, the claim number that I just gave to you was issued in its place.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] And, uh, sorry, one second. I address you, uh, we have sent the EOB.
[AGENT][NEUTRAL] That is correct, but
[CUSTOMER][NEUTRAL] To your fax number.
[AGENT][NEUTRAL] Mhm. And it was denied as a duplicate because
[CUSTOMER][NEUTRAL] Mm. OK. OK. OK.
[AGENT][NEUTRAL] Before you submitted that,
[AGENT][NEUTRAL] The insured themselves filed all of the necessary documents for the same data service and that it was processed with payment made to the insured.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, OK. OK. Uh, what we need to process the next action to complete the claim? May I know the, mhm.
[AGENT][NEUTRAL] Mhm. And you would.
[AGENT][NEUTRAL] You would have to contact the claim is completed and you would have to contact the insured if you have any questions regarding the benefit that was issued to them.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, we need to build the patient, uh, the remaining amount that is correct.
[AGENT][NEUTRAL] We do not determine patient, no. We do not determine patient responsibilities. That would be up to the provider.
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] responsibilities that would be best.
[CUSTOMER][NEUTRAL] Um, means you are saying that insured person.
[AGENT][NEUTRAL] I'm saying that APL.
[CUSTOMER][NEUTRAL] We need to contact the benefit has been made.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm saying that APL does not determine patient responsibility.
[CUSTOMER][NEUTRAL] OK. What is the next step? I don't understand what we need the next action to process the claim.
[AGENT][NEUTRAL] The claim has been processed.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I place you on a brief hold?
[AGENT][NEUTRAL] For just a moment.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hey.
[AGENT][NEUTRAL] Uh, locked you out of where?
[AGENT][NEUTRAL] I haven't locked anything.
[AGENT][NEUTRAL] I don't know. I've got, I've got one of my Indians on hold.
[AGENT][NEUTRAL] I'm not worried about