AccountId: 011433970860
ContactId: 56a8509c-3a33-4458-9373-90a1b29fedb4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 947159 ms
Total Talk Time (AGENT): 149960 ms
Total Talk Time (CUSTOMER): 97980 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-3.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/56a8509c-3a33-4458-9373-90a1b29fedb4_20250409T13:46_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, [PII]. Hi. I'm calling from uh South Miami Hospital. And uh we sent in a claim for a member and just checking status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status, and may I have your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And Miss [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] It is 1 2nd, I'll tell you.
[CUSTOMER][NEUTRAL] 02462244 MLB it looks like or ML 8?
[AGENT][NEUTRAL] OK, thank you. And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII]. Uh, date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And I need the um date of service and the amount of the claim.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, the bill amount is $6,358 and we're requesting the $2000 that was applied to the deductible.
[AGENT][NEUTRAL] All right, OK, let me see if I can find that claim.
[AGENT][NEUTRAL] And Ms. [PII], I just need to let you know that for the future, um, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let me pull this EOB which she was denied a certificate, but I don't have another claim, so let's see what's going on.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Oh boy, OK, yeah.
[AGENT][NEUTRAL] 283.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sometimes you can't fix everything with the website. You have to have a human being.
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] Oh wow.
[AGENT][NEUTRAL] Yeah, um.
[AGENT][NEUTRAL] It's really strange. I don't see another claim. Let me look at the history.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] process this.
[AGENT][NEUTRAL] OK, I will have to send this claim for review because I do not see another claim and it was a duplicate, so I'm not sure where the other claim is, um, so let me go ahead and send this out for a review. Do you mind holding for me while I send this request out?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] No, OK, thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding.
[AGENT][NEUTRAL] Miss, I do apologize for that long way. OK, so I went ahead and just send in a request for them to review the claim and reprocess if needed, which more than likely they need to reprocess. So, um, it's gonna be 24 to 48 hours for them to go ahead and go over the claim and see what decision they need to make, OK? So if you, um, want to get like an update, you can call us back in about 48 business hours, OK?
[CUSTOMER][NEUTRAL] Mhm oh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, do I have a reference number?
[AGENT][NEUTRAL] And we don't have reference numbers you can use my name and today's date if you will.
[CUSTOMER][NEUTRAL] OK. Do you have an initial? I have so.
[AGENT][NEUTRAL] Mhm. Yes, [PII].
[CUSTOMER][NEUTRAL] OK, well,
[CUSTOMER][POSITIVE] [PII] OK. And today's date? [PII]. OK, perfect. Thank you, [PII]. Thank you very much. Bye-bye.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct, yes.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, basically I just need this claim um process, so I don't, you know.
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] And there's
[CUSTOMER][NEUTRAL] To know whether or not they're gonna pay for it in order to advise the member that they have, they have to pay it.
[AGENT][NEUTRAL] Yeah, I understand. I do. OK, so yeah, it, it is gonna be reviewed and like I said, usually it just only takes 24 to 48 hours for them to review and see what they're gonna do, OK?
[CUSTOMER][POSITIVE] OK. All right, thank you.
[AGENT][POSITIVE] All right, have a good day. You're welcome Miss [PII]. Bye bye.
[CUSTOMER][NEUTRAL] Bye.