AccountId: 011433970860
ContactId: 3ae8610c-99c1-4a30-9d6e-a65c3ef194a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 601219 ms
Total Talk Time (AGENT): 238473 ms
Total Talk Time (CUSTOMER): 136923 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/3ae8610c-99c1-4a30-9d6e-a65c3ef194a9_20250425T20:41_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check connecting status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status and [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. And you're calling from which facility from my location?
[CUSTOMER][NEUTRAL] I didn't get you, sorry?
[AGENT][NEUTRAL] What's the name of the facility?
[CUSTOMER][NEUTRAL] Yes, the facility name is HCA Florida University Hospital.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, it's 24733997.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] Mm. You said 2473397?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Now what I pulled.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, that's fine. Um, can you check that number one more time because that's not who I'm calling.
[CUSTOMER][NEUTRAL] Uh, you're asking me to say the member ID once again?
[AGENT][NEGATIVE] Yes, or if you can verify, like check on it, make sure that that's the correct number because it's not pulling anything up. It's just kicking me out.
[CUSTOMER][NEUTRAL] Yes, it's 24733997.
[AGENT][NEUTRAL] And what's the name of the patient?
[CUSTOMER][NEUTRAL] Uh, the patient name is [PII]. Do you want me to spell it?
[AGENT][NEUTRAL] Yeah, I'll have to do a name search. What is um the spelling of the last name?
[CUSTOMER][NEUTRAL] Yeah, uh, the last name is [PII]. It's spelled as [PII].
[AGENT][NEUTRAL] OK. And how do you spell the first name?
[CUSTOMER][NEUTRAL] It's [PII]. It's spelled as [PII].
[AGENT][POSITIVE] Thank you one moment let me.
[AGENT][NEUTRAL] Let me do a name search, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have an address for Mr. [PII]?
[CUSTOMER][NEUTRAL] Yes, uh, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, uh, the address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, and what's his date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. All right, on the policy number just changed to 97 to 95.
[AGENT][NEUTRAL] And OK.
[CUSTOMER][NEUTRAL] 97295.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Just 5 numbers, am I right?
[AGENT][NEUTRAL] Uh, it's gonna be seven digits in total. So it's 02473395. So the last number is a 5, not a 7.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And um what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, the date of service is [PII], and the total charge amount is $38,209 even.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, bear with me because it looks like um.
[AGENT][NEUTRAL] Let me check this one really quick and you said [PII]. OK.
[AGENT][NEUTRAL] Let me pull this EOB, OK? And for the future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Is it one day or is it consecutive days?
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yes, it's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the one that is from [PII].
[AGENT][NEUTRAL] Um, that one, it looks like it's been processed twice. Let me check and see what happened to this one. OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So it looks like um this denial is indicating that koology, speech, or occupational therapy are not covered under the policy.
[AGENT][NEUTRAL] And then um there is some of the charges that was denied indicating that um the benefit payment has been made to the insured.
[CUSTOMER][NEUTRAL] You're stating that the payment was made to the patient. Am I right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Uh, how much was the amount paid?
[AGENT][NEUTRAL] We cannot release that information.
[CUSTOMER][NEUTRAL] OK. Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, when was the amount paid? Do you have the details?
[AGENT][NEUTRAL] We cannot release any information that is pertaining to the claim that we process under the member, that's personal information. I can only give you information about your claim and based on the claim that we process for you for the um.
[AGENT][NEUTRAL] Provider, um, it was received after we received the one for the insured, so it was paid directly to the insured and you can use that to send a bill to the insured.
[CUSTOMER][NEUTRAL] I didn't get you. So we have, uh, submitted a bill to you. Uh, you're stating that it was denied as non-covered. Am I right?
[AGENT][NEUTRAL] No. Mm mm.
[AGENT][NEGATIVE] No, there are 2 denials.
[AGENT][NEGATIVE] There are 2 denials on the claim. The first denial is indicating that it's a duplicate because it was processed under the insured and paid to the insured, and the other half is denied, indicating that we do not pay for kineology, speech or occupational therapy.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Yeah, uh, can you please provide me the claim number?
[AGENT][NEUTRAL] Yes, the claim number is 352.
[AGENT][NEUTRAL] 1735. Again, that's 3521735.
[CUSTOMER][NEUTRAL] And uh the received date and the process date of the claim?
[AGENT][NEUTRAL] OK, let me check and see what's the receipt date, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 25. OK, it was received [PII] process [PII].
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] And uh do you know what is the patient's responsibility?
[AGENT][NEUTRAL] No, we're just the secondary. You need to go back to the primary EOB.
[CUSTOMER][NEUTRAL] Yeah, OK. Thank you for those information. And can you please provide me the call reference number for this call?
[AGENT][NEUTRAL] We don't have reference numbers, you can use my name and today's date if you would like Miss [PII].
[CUSTOMER][POSITIVE] Yeah, OK. Thank you for your assistance. Have a great day.
[AGENT][POSITIVE] You as well thank you for calling APR. Have a good afternoon, Ms. [PII].
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][POSITIVE] You're welcome. Bye-bye.