AccountId: 011433970860
ContactId: 38d3ec2b-a452-48f2-8276-35515c938b63
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 247600 ms
Total Talk Time (AGENT): 111805 ms
Total Talk Time (CUSTOMER): 68379 ms
Interruptions: 1
Overall Sentiment: AGENT=1.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/38d3ec2b-a452-48f2-8276-35515c938b63_20250516T20:12_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, my name is [PII]. I'm just calling with Aventura Hospital to follow up on a claim.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII] no extension.
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] 01491529
[CUSTOMER][NEUTRAL] M for Mary, L for Larry, number 8.
[AGENT][NEUTRAL] OK, thank you. One moment while I get the member's information pulled up please.
[AGENT][NEUTRAL] I mean, [PII], any information that I provide will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The amount was $20,716.04.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim has been received 3 times. The most recent claim was denied the, I'm sorry, the last 2 times were denied as a duplicate of previously submitted expenses. Do you want the original claim status?
[CUSTOMER][NEUTRAL] Um, yes, we faxed the primary EOB for this claim.
[CUSTOMER][NEUTRAL] Back on [PII] and we were following up on that as well.
[AGENT][NEGATIVE] OK, we have not received that for for whatever reason that did not come through.
[AGENT][NEUTRAL] So you already have the original claim number?
[AGENT][NEUTRAL] BJ
[CUSTOMER][NEUTRAL] I have 3542327. Is that right?
[AGENT][POSITIVE] Uh, yes, ma'am, that is correct. Uh-huh.
[CUSTOMER][NEUTRAL] Um, should we fax it again to the same number?
[AGENT][NEUTRAL] I would if you, you said you faxed it on the [PII]. I don't even show that it's in the system. It does take about 24 hours or so for that to show up on a fax, but as today's the [PII]. So I would say yes, ma'am, to fax it again, the EOB.
[CUSTOMER][NEUTRAL] And I have the fax as [PII], is that right?
[AGENT][NEUTRAL] Yes ma'am, uh-huh attention claims department.
[AGENT][NEUTRAL] And you can even reference this claim number that I gave you and then DJ, I don't know, you may already have this uh website, but we do have a portal in which you should also be able to check claim status once it's been processed, and the website for our portal is secured. [PII].
[CUSTOMER][NEUTRAL] OK perfect and is there a reference?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you and is there a reference for our call today?
[AGENT][NEUTRAL] Yes, ma'am, um, you would use my name along with today's date.
[CUSTOMER][POSITIVE] Alrighty, thank you so much, [PII]. You have a great day.
[AGENT][POSITIVE] Well, you're welcome. Yes, ma'am, you too. And if that is all I could help you with, [PII], thank you again for calling APL. Have a wonderful weekend.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Bye bye. Thank you.