AccountId: 011433970860
ContactId: 4d819397-6134-4d4f-838a-c80a86e83c70
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1504140 ms
Total Talk Time (AGENT): 357349 ms
Total Talk Time (CUSTOMER): 331060 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/4d819397-6134-4d4f-838a-c80a86e83c70_20250117T15:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII] calling from provider office checking on claim status.
[AGENT][NEUTRAL] OK, and can you spell your name for me please? I can help you with the claim status.
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. It's [PII].
[CUSTOMER][NEUTRAL] And my initial is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Ah, thanks, yeah.
[AGENT][NEUTRAL] [PII]. OK, thank you for uh spelling your name for me. Can I get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Yeah. It's [PII].
[AGENT][NEUTRAL] And then what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] And Ms. [PII]'s policy number, please?
[CUSTOMER][NEUTRAL] Yeah, uh, it's.
[CUSTOMER][NEUTRAL] 01578526 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Thank you and then what is the date of service?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] And the charge amount please?
[CUSTOMER][NEUTRAL] Yeah, it's $6,575.40.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Yeah, could you please repeat again?
[AGENT][NEUTRAL] Yes, what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] Yeah, it's transfer of the $1,782 to the secondary.
[AGENT][NEUTRAL] OK, thank you, and then can you please give me the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Yeah, it's Holy Cross Hospital, Fort Lauderdale, parent location.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, Ms. [PII].
[AGENT][NEUTRAL] Oh, I said that wrong. [PII]. Thank you. uh.
[CUSTOMER][POSITIVE] Yeah, I can. Yeah.
[AGENT][NEUTRAL] I'm gonna put you on a brief hold while I look up this claim for you and I will be right back.
[CUSTOMER][POSITIVE] OK, take your time.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 600
[AGENT][NEUTRAL] 57
[AGENT][NEUTRAL] There it is
[AGENT][NEUTRAL] 3
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi Miss [PII], this is [PII] back with you again. I do have the claim. I haven't found it. The claim number is 352-2310.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Let's give you the received date.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] And we process the claim on [PII].
[CUSTOMER][NEUTRAL] I I.
[AGENT][NEUTRAL] The claim was denied because the benefits for the calendar year for outpatient had been met.
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yeah, could you please repeat the dinner reason?
[AGENT][NEUTRAL] The denial reason?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The benefits for the calendar year had been met. They she exhausted her benefits for the year.
[CUSTOMER][POSITIVE] Benefits, yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] May I know the reason?
[CUSTOMER][NEUTRAL] Sorry, sir, denial date.
[AGENT][NEUTRAL] Oh, the, the denial date was.
[AGENT][NEUTRAL] The 2nd date I gave you, let me look it up again.
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Yeah. Your name is [PII], right?
[AGENT][NEUTRAL] No, my name is [PII]
[CUSTOMER][NEUTRAL] Oh yeah. Actually, sorry for asking that. Could you please tell me the denial reason once? Could you please spell the name? Benefit.
[AGENT][NEUTRAL] The outpatient benefits.
[AGENT][NEUTRAL] For the calendar year have been met.
[CUSTOMER][NEGATIVE] Calendar, your voice is breaking.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] The the outpatient benefit.
[AGENT][NEUTRAL] For Allen
[AGENT][NEUTRAL] Have been met.
[CUSTOMER][NEUTRAL] It means uh that for the outpatient benefit, right?
[AGENT][POSITIVE] Right, the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] How much amount?
[AGENT][NEUTRAL] $2500 per calendar year and she exhausted that.
[CUSTOMER][NEUTRAL] OK. Is there any update? I actually I saw in this the reason in my previous, sir?
[CUSTOMER][NEUTRAL] Is there any update?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, [PII], I did not receive any EOB. Could you please fax through the EOB?
[AGENT][NEUTRAL] Yes, can you give me your fax number please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on hold while I fax that to you. I'll be right back.
[CUSTOMER][NEUTRAL] Yeah, how much time it will take?
[AGENT][NEUTRAL] Just a couple of minutes.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] May I know the call reference number?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on, talk to each other.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi, this is [PII] back with you again. I do have that fax on its way to you.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] What do you want?
[AGENT][NEUTRAL] Yes, I have the fax on its way to you.
[CUSTOMER][POSITIVE] Yeah, thank you and.
[CUSTOMER][NEUTRAL] May I know the call reference number?
[AGENT][NEUTRAL] You can use my name at today's date.
[CUSTOMER][NEUTRAL] Yeah. Yeah, sorry, I have another account. Could you please help me that?
[AGENT][NEUTRAL] OK, you have
[AGENT][NEUTRAL] You said?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, is it for the patient?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello, is it for the same patient?
[CUSTOMER][NEUTRAL] Yeah, it's different patient.
[AGENT][NEUTRAL] Different patient. OK, let me put my
[CUSTOMER][NEUTRAL] No, no, it's different patient.
[AGENT][NEUTRAL] OK, let me put my notes in real quick and I'll get that um next patient for you, just a second.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, what is the next patient's name?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] [PII]. OK, and what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Yeah, now.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] And her policy number please?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 0247326 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK thank you and then what is the date of service?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] And the charge amount please?
[CUSTOMER][NEUTRAL] Yeah, it's $909 even.
[AGENT][NEUTRAL] And then the charge after the primary insurance paid their part.
[CUSTOMER][NEUTRAL] Yeah, it's start out the $20 only to the secondary insurance.
[AGENT][NEUTRAL] OK, and what is the name of the facility?
[CUSTOMER][NEUTRAL] Yeah, it's same facility, Holy Cross Hospital for Ladderdale parent location.
[AGENT][NEUTRAL] OK. All right. I'm gonna put you on hold again while I look up this.
[AGENT][NEUTRAL] I I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh, here PRTQ.
[AGENT][NEUTRAL] 247326.
[AGENT][NEUTRAL] Can I get her policy number one more time for you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, yes, it's 02.
[CUSTOMER][NEUTRAL] 473-26 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] OK, that policy number is not pulling up, it's missing a digit.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Yeah. Could you please recheck the data service?
[AGENT][NEUTRAL] I can check by name. Let me see.
[AGENT][NEUTRAL] I can't check check data, sir.
[CUSTOMER][NEUTRAL] The member ID is not found it right?
[AGENT][NEUTRAL] Right, I can't check data service without the policy number, so.
[AGENT][NEUTRAL] Name.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, OK. Can I move to another account?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, that's
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can you say the patient name?
[AGENT][NEUTRAL] Yes, what's the next patient's name?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] OK, and then what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] And the policy number, please?
[CUSTOMER][NEUTRAL] Yeah, it's 02413470. M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] OK and the data service.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] And the charge amount please?
[CUSTOMER][NEUTRAL] Yeah, it's $5,326 even.
[CUSTOMER][NEUTRAL] And that transfers out the $1,384.76.
[AGENT][NEUTRAL] Thank you. And is it probably crossed also?
[CUSTOMER][NEUTRAL] Yeah, it's still in process.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on hold. I'm gonna try to find that for us and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you so much for holding for me. I tried to find the claim and I do not see a claim on file for that amount for [PII].
[CUSTOMER][NEUTRAL] Yeah. Could you please repeat again?
[AGENT][NEUTRAL] The claim is not on file?
[CUSTOMER][NEUTRAL] You said no claim 15, right?
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] May I know the effective date of this patient?
[AGENT][NEUTRAL] The effective date is [PII] and the policy is still active.
[CUSTOMER][POSITIVE] Yes, could you please tell me the effective, sorry for asking.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the policy is still active.
[CUSTOMER][NEUTRAL] Yeah, still is active.
[CUSTOMER][NEUTRAL] Yeah. May I know the mailing address to resubmit the claim?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Claims
[AGENT][NEUTRAL] And that is [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] [PII]. It's OK [PII].
[CUSTOMER][NEUTRAL] Yeah, could you please spell that?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] After that?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah, sorry for that. Could you please, it's [PII].
[AGENT][NEUTRAL] And the state is also [PII].
[CUSTOMER][NEUTRAL] Oh, it's [PII]
[CUSTOMER][NEUTRAL] And after that?
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah, it's BY means.
[AGENT][NEUTRAL] I'm sorry, what did you just say?
[CUSTOMER][NEUTRAL] Yeah, it's, it's [PII] After that, [PII] is right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Sorry, I did not understand. Could you please repeat again? My headset is.
[CUSTOMER][NEUTRAL] Breaking, that's why.
[AGENT][NEUTRAL] OK, it's
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's in [PII]. Zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah. May I know the payer ID?
[AGENT][NEUTRAL] 60
[AGENT][NEUTRAL] 01.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, could you please
[CUSTOMER][NEUTRAL] Repeat again.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] May I know the timely filing limit?
[AGENT][NEUTRAL] We do not have one.
[CUSTOMER][NEUTRAL] Because submit the how much time?
[CUSTOMER][NEUTRAL] It's one year or this is.
[AGENT][NEUTRAL] We do not have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah. May I know the call reference number?
[AGENT][NEUTRAL] Yes, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Yeah, a s[PII]. Thank you for assisting me.
[CUSTOMER][POSITIVE] Thank you. Have a great day.
[AGENT][POSITIVE] You're very welcome you.
[AGENT][POSITIVE] But great, yes, have a good weekend. Thanks for calling APS.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Yeah, thank you. Bye bye.