AccountId: 011433970860
ContactId: 5ae4a222-c000-46b6-b58d-9f33a7f8d9fa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1230109 ms
Total Talk Time (AGENT): 325651 ms
Total Talk Time (CUSTOMER): 238107 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/5ae4a222-c000-46b6-b58d-9f33a7f8d9fa_20250617T19:26_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on the claim status.
[AGENT][NEUTRAL] Sure, I can assist you with claim status, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, that is [PII].
[AGENT][NEUTRAL] Thank you and may I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Government
[CUSTOMER][NEUTRAL] Florida Aventura Hospital.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Yeah, the policy number will be 02579289.
[AGENT][NEUTRAL] OK. What is the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The name will be [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] and charges will be $3,143 and even.
[AGENT][NEUTRAL] OK. So [PII], the amount of $3,143 even.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for future. You can check claim status online through our website at [PII], and that's just optional and bear with me. Let me go ahead and pull the ELB on this one, OK? One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, here we go.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] I'm still waiting on the system.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] The linear reporting any travel a complete.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] OK. So it looks like we processed the claim on [PII] and the claim was denied. The reason for this denial is we have received the primary explanation of benefits. However, the explanation of benefits that does not list the amount applied towards the deductible, co-payment or co-insurance. So we need a detailed explanation of benefits for consideration.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. May I have the receipt date of this claim?
[AGENT][NEUTRAL] Mhm. Sure, it was received on [PII].
[CUSTOMER][NEUTRAL] OK, thanks. May I have the claim number?
[AGENT][NEUTRAL] Alright, the claim number is 359-7933.
[CUSTOMER][NEUTRAL] OK, may I have the fax number?
[AGENT][NEUTRAL] The fax number is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, but I have sent, uh, you will be, uh, you will be already on [PII]. Could you please check on that?
[AGENT][NEUTRAL] We have not received anything after this claim. This is the last thing that we have processed and received. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No problem. I'll send it again. I do have another two claims. Could you please check on that?
[AGENT][NEUTRAL] Is it for the same member or different member?
[CUSTOMER][NEUTRAL] That is for the different number?
[AGENT][NEUTRAL] OK, let me go ahead and uh make a note on this one before we we move forward to another policy. OK, Miss [PII] 1 moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, what is the next policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number will be
[CUSTOMER][NEUTRAL] 01868782.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, the name will be
[CUSTOMER][NEUTRAL] One moment, uh, [PII].
[AGENT][NEUTRAL] OK, what's her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service, the amount of the claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. How much is the total charge?
[CUSTOMER][NEUTRAL] $46,541.10.
[AGENT][NEUTRAL] OK. Now it's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Is it a range of dates or it's a single date?
[CUSTOMER][NEUTRAL] Yeah, that is from
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK bear with me just a minute.
[CUSTOMER][NEUTRAL] Allergic to the
[AGENT][NEUTRAL] One moment, I'm just calling the one that may seem that is probably it. I'm not sure but.
[AGENT][NEUTRAL] Let me check this one.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm, what's the name of the provider?
[CUSTOMER][NEUTRAL] Valley Regional Medical.
[AGENT][NEUTRAL] OK. Can you check the total charge amount one more time because I got one, but it's a little bit different on the amount.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, I do see $41,754.99. Is that correct?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah, that's the one I found. OK. All right, so let me go ahead and pull the details on this 11 moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it's gonna be the same uh denial reason as the one prior. There is nothing applied towards the deductible co-payment and co-insurance, so we need a detailed explanation of benefits.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. May I have the date?
[AGENT][NEUTRAL] Uh, see this 1 [PII].
[AGENT][NEUTRAL] Um, one moment.
[AGENT][NEUTRAL] OK, this one was received [PII], processed [PII].
[CUSTOMER][NEUTRAL] OK. May I have the claim number?
[AGENT][NEUTRAL] Claim number is 3596417.
[CUSTOMER][NEUTRAL] OK, thanks for that. And is that the same uh fax number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, thank you. I do have a uh last claim. Is that OK to check?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, bear with me just a minute. Let me go ahead and make a note on this one as well. OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Uh, one moment, please. Uh, one moment, sorry. Uh, uh, we have already sent you the UB. Could you please verify with that, uh, I see um UV, uh, has already been sent.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] When was that sent?
[CUSTOMER][NEUTRAL] Uh, it has been sent on.
[CUSTOMER][NEUTRAL] 613 of 225. Uh, you'll, you'll be receive that on [PII].
[AGENT][NEUTRAL] 6:13.
[AGENT][NEUTRAL] OK, let me check and see if it's on file. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, let me look at this pending claim and see if this is your claim. One moment.
[AGENT][NEUTRAL] Not it, check the other one.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] No, no, we have not received that yet.
[CUSTOMER][NEUTRAL] OK, thanks for that. Uh, shall we go on to the next claim?
[AGENT][NEUTRAL] You have another one, bear with me.
[AGENT][NEUTRAL] Let me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me finalize it now.
[AGENT][NEUTRAL] OK, um, what is the next policy?
[CUSTOMER][NEUTRAL] Yeah, the policy number will be
[CUSTOMER][NEUTRAL] 1343156
[CUSTOMER][NEUTRAL] MLB ML 8.
[AGENT][NEUTRAL] OK what's the name and date of birth?
[CUSTOMER][NEUTRAL] The name will be [PII].
[AGENT][NEUTRAL] What's her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, how much is the total charge?
[CUSTOMER][NEUTRAL] $7,426.12.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull this out.
[CUSTOMER][NEUTRAL] Yeah. Hello?
[CUSTOMER][NEUTRAL] Can.
[AGENT][NEUTRAL] I'm still waiting on the AOB bear with me.
[AGENT][NEUTRAL] OK, so we processed this claim on [PII].
[AGENT][NEUTRAL] And the claim was denied. The reason for this denial is the outpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So could you please repeat that again?
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] Yes, the outpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK. One moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] May I know the plan type for this?
[CUSTOMER][NEGATIVE] out of network.
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know it has been processed as in-network or out of network?
[AGENT][NEUTRAL] We are the secondary, there's no network.
[CUSTOMER][NEUTRAL] OK. Uh, may I have the date of this claim?
[AGENT][NEUTRAL] OK, yes, um, let's see [PII]. Let's received [PII] process [PII].
[CUSTOMER][NEUTRAL] May I have a claim number?
[AGENT][NEUTRAL] Yes, um, the claim number is.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, 3582406.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, thank you. Could you please send us a copy of any fax?
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] Yeah, the fax number will be 844-902.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me go ahead and send this out to you. Do you mind holding for me while I send this one out?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Ms. [PII]. Yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, thanks for that. Uh, may I have your name, please?
[AGENT][NEUTRAL] OK, my name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] OK. And may I have your card reference number?
[AGENT][NEUTRAL] We don't have reference numbers um you can use my name in today's date.
[CUSTOMER][POSITIVE] OK. Thank you. Have a good day.
[AGENT][POSITIVE] You as well thank you for calling ATM. Bye bye.