AccountId: 011433970860
ContactId: 4db22be1-0615-4785-97a5-5c4b765f9a53
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 858780 ms
Total Talk Time (AGENT): 304827 ms
Total Talk Time (CUSTOMER): 270538 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/4db22be1-0615-4785-97a5-5c4b765f9a53_20250423T18:40_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm calling because I submitted a few claims, um, well, the hospital did for, for me, and I wanted to know if you guys received them. It's for Nicholas uh Children's Hospital.
[AGENT][NEUTRAL] OK, so you're wanting to check claim status for yourself, is that correct?
[CUSTOMER][NEUTRAL] It's for my daughter. Her name is [PII].
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] Sure, that's 01813054.
[AGENT][NEUTRAL] OK, thank you. Give me a moment please to get the policy information pulled up and then I will have to verify several things with you first for security, so just a moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so first off [PII], any information provided would be a verification of benefits and not a guarantee of payment. I will need to verify.
[AGENT][NEUTRAL] As I stated several things with you for security. So for the primary policy holder's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you. Your date of birth?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then again, your child's name and date of birth that you're calling about?
[CUSTOMER][NEUTRAL] Yeah, [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. And the home mailing address, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we would have on file for Mr. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service for [PII] that you're calling?
[AGENT][NEUTRAL] About
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so we did receive a claim for the for [PII] for this data service. Now this has been denied at this point. Give me one moment to pull those remarks up.
[AGENT][NEUTRAL] OK, so the remark on here.
[CUSTOMER][NEUTRAL] Yeah, I call them back.
[AGENT][NEUTRAL] Oh, you already know the remark?
[CUSTOMER][NEUTRAL] I called them back and they resubmitted it. Yeah, they resubmitted it um about 2 weeks ago, so I was, I was wondering if you received the new one after the denial.
[AGENT][NEUTRAL] No, ma'am. We have not, not as of yet.
[AGENT][NEUTRAL] We were needing a details.
[CUSTOMER][NEGATIVE] So what is, why isn't it, yeah, I've called them a couple of times and they keep saying they submitted again and again, but it's not reaching you guys, and I'm waiting for my refund because I paid this in full to the hospital. So, I, I need this claim money to be, you know, sent to the hospital so they can refund me, but it's like not getting to APL. I don't understand.
[AGENT][NEUTRAL] Um
[AGENT][NEGATIVE] Just now I mean, I can't say, I don't know how they're sending it.
[AGENT][NEUTRAL] What address there
[AGENT][NEUTRAL] Sending it to you if they're faxing it, but we
[CUSTOMER][NEUTRAL] Yeah, because it's like you.
[AGENT][NEUTRAL] This claim that the only thing that we currently have on file for Skyler was received [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[AGENT][NEUTRAL] And we have not received any additional information.
[CUSTOMER][POSITIVE] OK. All right. I'm gonna call them once again.
[AGENT][NEUTRAL] Since that time.
[CUSTOMER][NEUTRAL] All righty. Um, and also, do, do you have another?
[AGENT][POSITIVE] Now, I'll be happy to give you a fax number.
[CUSTOMER][NEUTRAL] Fax number, OK.
[AGENT][NEUTRAL] That they can send the necessary information to and that is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Attention claims department.
[CUSTOMER][POSITIVE] OK, perfect. Thank you. I also have another uh status um I'd like to check up on, please. It's for
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's for myself, uh, data service [PII].
[CUSTOMER][NEUTRAL] And it's for Anne Association, Greater Miami.
[CUSTOMER][NEUTRAL] And this one, it looks like you reissued a new check when I called the last time for this.
[AGENT][NEUTRAL] OK, give me just
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me know when you're ready.
[AGENT][NEUTRAL] OK, so one moment, let me get out a scholar's record.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And what was the total bill amount for that data service for you?
[CUSTOMER][NEUTRAL] Yes, the 1st $713.80. So apparently AS Association Greater Miami never received the first check, so you reissued a new one, which I hope they received, um, but I only got an explanation of benefits for that one amount. I had another amount that they submitted for and that I haven't received any update on.
[CUSTOMER][NEUTRAL] So that amount is $627.80.
[AGENT][NEUTRAL] 62,780 for the same date of service?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] OK, so I don't see a claim on file for that I be the service.
[CUSTOMER][NEUTRAL] For [PII]?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Right. Yes, ma'am.
[AGENT][NEUTRAL] Not for 600, not for $627[PII].
[CUSTOMER][NEUTRAL] OK, let me see here one second. Um, how about [PII]?
[AGENT][NEUTRAL] And the build out for [PII]?
[AGENT][NEUTRAL] There's no claim on file for you.
[CUSTOMER][NEUTRAL] OK, because I have a, I have a bill in front of me. I just don't see the date of service. I see a whole bunch of different dates because it says.
[CUSTOMER][NEUTRAL] Service doctor, commercial adjustment, deductible, and they all have a different date.
[CUSTOMER][NEUTRAL] So, the [PII] looks like [PII].
[AGENT][NEUTRAL] Well, the dates should be.
[AGENT][NEUTRAL] I'm sorry. So 627-80 was for what date again?
[CUSTOMER][NEUTRAL] Can you check if you see it on [PII]?
[AGENT][NEUTRAL] No ma'am, there's no claim on file for you for that data service for 68.
[CUSTOMER][NEUTRAL] Yeah, this is strange because I did get charged for that, um, and I have the bill in front of me. I just don't know the exact.
[CUSTOMER][NEUTRAL] State of service.
[CUSTOMER][NEUTRAL] Do you have any other claims for AS Association Greater Miami?
[AGENT][NEUTRAL] Well, I have to, I can't look for just a provider. I'm gonna need to search by the data service.
[AGENT][NEUTRAL] For you.
[CUSTOMER][NEUTRAL] You can search by provider or total amount?
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEGATIVE] No, I can't.
[CUSTOMER][NEUTRAL] Um, OK. Um, I did verify all my personal information though, right?
[AGENT][NEUTRAL] Yes, ma'am, you did. Uh-huh.
[CUSTOMER][NEUTRAL] Do you need anything else that I can verify?
[AGENT][POSITIVE] No, ma'am. Thank you verified everything.
[CUSTOMER][NEUTRAL] OK, so you just can't tell me if you have a claim there for this amount, even though I cannot determine here what.
[AGENT][NEGATIVE] Well no
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] So, yes, ma'am. I just need to know the, the dates of service so that I can look to see who we've received a claim for.
[AGENT][NEUTRAL] 40.
[AGENT][NEUTRAL] In looking at your profile, we uh.
[CUSTOMER][NEUTRAL] So the date of
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Now your profile on every single claim we've received some claims this year for dates of service that was, you know, all.
[AGENT][NEUTRAL] A long time ago. I can't just go by go by when we received it or processed it since we don't have a timely filing.
[CUSTOMER][NEUTRAL] OK. Yeah. It, it has to be sometime in April. That's when I had a surgery. So [PII], I was, I was hospitalized for 3 days.
[CUSTOMER][NEUTRAL] So it was some time then.
[AGENT][NEUTRAL] All I can do is look through every claim. So we've received one for [PII] that we paid $350 to West Kendall Baptist for you.
[CUSTOMER][NEUTRAL] OK, I have that one.
[AGENT][NEUTRAL] The next claim
[AGENT][NEUTRAL] was for 417 for [PII] Women's Care. That benefit was $1,479.52 that was paid for data service 417.
[CUSTOMER][NEUTRAL] OK, I have that.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] A $75
[AGENT][NEUTRAL] Benefit Baptist Hospital also for 417.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, for 417 for comprehensive pathology associates, there was a $113.44 benefit paid.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the one
[AGENT][NEUTRAL] And for South Miami, um, Creek.
[AGENT][NEUTRAL] That was a benefit of 358.94 also for 417.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the last one is going to be
[AGENT][NEUTRAL] The anesthesia Associates Greater Miami for 417, and that was the $713.80 benefit and that's all of the claims that we have for you.
[CUSTOMER][NEUTRAL] OK, so there's nothing with the 62,780 that you.
[CUSTOMER][NEUTRAL] have for me.
[CUSTOMER][NEUTRAL] As of yet.
[AGENT][NEUTRAL] Mm. No, ma'am.
[AGENT][NEUTRAL] No, ma'am. There's not.
[CUSTOMER][POSITIVE] OK. All right. I'll give them a call back and um tell them to resubmit that one. Thank you so much for your help.
[AGENT][POSITIVE] Absolutely. You're very welcome. Is there anything else that I can help you with today, [PII]?
[CUSTOMER][POSITIVE] No, thank you. You've been helpful.
[AGENT][POSITIVE] OK, well, it was my pleasure and thank you again for calling APL. I hope you have a very nice afternoon.
[CUSTOMER][POSITIVE] Thanks. Bye-bye.
[AGENT][NEUTRAL] Yes.