AccountId: 011433970860
ContactId: 55b35d46-62c0-4bc3-8bf0-6365075e7e60
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 578039 ms
Total Talk Time (AGENT): 190933 ms
Total Talk Time (CUSTOMER): 112587 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/55b35d46-62c0-4bc3-8bf0-6365075e7e60_20250325T20:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from West Kendall Baptist Hospital on a claim.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with the claim. Can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] H as in Harry, J as in Jack, [PII].
[AGENT][NEUTRAL] OK, do you see another number? Yeah, that's not our policy number.
[CUSTOMER][NEUTRAL] Never seen that.
[CUSTOMER][NEUTRAL] No, I was just saying I've never seen that number. Let me look on the EOB hold on.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] 024.
[CUSTOMER][NEUTRAL] 56701.
[AGENT][NEUTRAL] OK, let me pull it up with that number.
[AGENT][POSITIVE] That sounds like a good one.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I've got her pulled up. Can you please give me the date of service?
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] And the charge amount please?
[CUSTOMER][NEUTRAL] Total bill amount was $3,392.
[AGENT][NEUTRAL] OK, and then what was the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Um, the balance was.
[CUSTOMER][NEUTRAL] Hold on, I add it.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh hold on I'm typing nothing.
[CUSTOMER][NEUTRAL] Balance after primary was 2, I'm $35.20.
[CUSTOMER][NEGATIVE] But we only got $300 which was the co-pay. We didn't get the deductible.
[AGENT][NEUTRAL] OK, alright, let me pull this claim up. I'm gonna put you on a brief hold while I pull it in and I will be right back.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Ms. [PII], real quick, do you have the claim number?
[CUSTOMER][NEUTRAL] Yes, I do. That's 354.
[AGENT][NEUTRAL] OK, well
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 863 2.
[AGENT][NEGATIVE] 354 8. I didn't get the right.
[CUSTOMER][NEUTRAL] 354-863-2
[AGENT][NEUTRAL] 863-2. OK, let me just try to see if I can just pull up that EOB and see if there's any remarks.
[CUSTOMER][NEUTRAL] I'm looking at it. I don't see anything.
[AGENT][NEUTRAL] OK, according to this EOB for this claim 354-863-2.
[AGENT][NEUTRAL] Looks like the charge amount was for the ER of $300 and we paid $300.
[CUSTOMER][NEUTRAL] Well, that was the co-pay after the primary?
[CUSTOMER][NEUTRAL] There is a deductible also from the primary.
[AGENT][NEUTRAL] OK, so what I'm going to need to do is I'll send in a request for a claims examiner to call you back to find out about the deductible not being paid.
[AGENT][NEUTRAL] So I'm gonna put you on a quick hold while I.
[CUSTOMER][NEUTRAL] OK, are deductibles covered?
[AGENT][NEUTRAL] Well, this policy does help with deductible co-pay or co-insurance. Now, let me see what the benefits are.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] For outpatient.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Cause it goes by facility and it looks like the ER is what was paid.
[CUSTOMER][NEUTRAL] Well, the $300 is the co-pay of the primary.
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEGATIVE] It's not the ER charge.
[AGENT][NEGATIVE] Right, right, because we don't, we don't pay for.
[CUSTOMER][NEUTRAL] The ER chart.
[AGENT][NEUTRAL] Anything but deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] Right, and co-pay was paid, but not the deductible.
[AGENT][NEUTRAL] OK, so let me look and see um I've got another claim here let me see if this is yours, what's the name you said it was Kindle?
[AGENT][NEUTRAL] Hospital
[CUSTOMER][NEUTRAL] West Kendall Baptist Hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I don't see anything else from your facility so the best thing for me to do is to go ahead and send in a request for somebody from the claims department to call you a claims examiner, and they can go over with you as far as the deductible goes and advises what to do if something else needs to be sent in or if there's a reason why it wasn't paid.
[AGENT][NEUTRAL] So I'm gonna put you on a quick hold while I get that um request in to them and the phone number that you're calling from the [PII], is that a good number for them to call you back on?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And do you have an extension?
[CUSTOMER][NEUTRAL] No, ma'am, that's direct.
[AGENT][NEUTRAL] OK, good. All right. And Ms. [PII], what is the first initial of your last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, alright, it's gonna be a quick hold. I'm gonna get that together so I can send it to them so you can get a call back.
[CUSTOMER][NEUTRAL] Thank you. You are on hold.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, Ms. [PII], I've got that request and for somebody from the claims department to give you a call and you should receive a call within 24 hours.
[CUSTOMER][NEUTRAL] OK, thank you. May I have a call reference number, please?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, [PII]
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][POSITIVE] Thank you, Miss [PII]. You have a wonderful day and thanks for calling APO.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye bye.