AccountId: 011433970860
ContactId: 578c466c-fd39-4091-8cdc-d1f50aa8b744
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 464220 ms
Total Talk Time (AGENT): 136063 ms
Total Talk Time (CUSTOMER): 157919 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/578c466c-fd39-4091-8cdc-d1f50aa8b744_20250107T21:50_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling on behalf of provider's office. Can you please help?
[AGENT][NEUTRAL] Uh yes, Miss [PII], can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. Callback number, it's [PII].
[CUSTOMER][NEUTRAL] [PII] and it's a direct line?
[AGENT][NEUTRAL] OK, thank you Miss [PII] and you asked for my help can I please ask you um what it is that you would need help with?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Uh yes, I'm calling in regards to claims.
[AGENT][NEUTRAL] OK, I can absolutely help you with the claim status. What is the patient's name?
[CUSTOMER][NEUTRAL] Uh, member's first name, it's [PII], that is [PII]. Last name, it's [PII]. That is [PII] again.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Member's date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And then what is [PII]'s policy number?
[CUSTOMER][NEUTRAL] Um, here it shows 17953.
[AGENT][NEUTRAL] OK, let me look and see if that policy will pull in for us.
[AGENT][NEUTRAL] OK, that looks like it could be the group number. Do you see a number that starts with a 01 or 02?
[CUSTOMER][NEUTRAL] OK. Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, let me just pull up the member's, uh, ID card if I have here with me. Uh, just a moment, please bear with me.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, sure, go ahead and take your time please.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Um, I don't find any.
[CUSTOMER][NEUTRAL] Uh, number here. I, I do have here, uh, some certificate number.
[AGENT][NEUTRAL] For inpatient or outpatient certificate number, one of those numbers would work.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] OK. So one, it is uh 1459008, M as in Mike, L Lima, number 7.
[AGENT][NEUTRAL] OK, let me pull that number in.
[CUSTOMER][POSITIVE] OK, sure, thank you.
[AGENT][NEUTRAL] You're very welcome. OK, I've got her pulled up. What is the date of service for Ms. [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure. So, the date of service is [PII] with the billed amount of $390 390 dollars.
[AGENT][NEUTRAL] OK, and then what is the amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] OK. So the amount left, it's $4.33.
[AGENT][NEUTRAL] And what is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] It's Women's Care Florida LLC.
[AGENT][NEUTRAL] OK, Miss [PII], I'm gonna put you on a brief hold while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK thank you. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi Miss [PII], this is [PII]. So I did find the claim and the claim number is 3541611.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You received the claim on [PII].
[AGENT][NEUTRAL] And process the claim on [PII]. The claim was denied because the services were rendered after the policy terminated.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And can you help me with the member's policy?
[AGENT][NEUTRAL] And I'm looking to see.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am, um, I do not see.
[CUSTOMER][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She has any policies on file.
[CUSTOMER][NEUTRAL] Yeah, I'm so, I'm so sorry your voice is cutting in and out.
[AGENT][NEUTRAL] That are active.
[CUSTOMER][NEUTRAL] Yeah. Uh, so, uh, when was the, uh, member's policy dominated?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, alright, um, OK, thank you so much and uh can you please repeat the claim number once again because uh there was a disturbance actually.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, the claim number is 3541611.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much for, for your help. And uh can you help me with the reference number for our call today?
[AGENT][NEUTRAL] Yes ma'am, you can use my name. It's [PII] and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Thank you so much for your help. It was great talking to you.
[AGENT][POSITIVE] It was good talking to you too, Miss [PII]. You have a good rest of your day and thank you for calling APL.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you. Bye-bye. Take care.
[AGENT][NEUTRAL] Mm bye bye. You too.