AccountId: 011433970860
ContactId: 6152b0d2-2fe5-4732-89b2-88dd34dbd71d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 317420 ms
Total Talk Time (AGENT): 148370 ms
Total Talk Time (CUSTOMER): 80794 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/6152b0d2-2fe5-4732-89b2-88dd34dbd71d_20250127T17:05_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, yes, good afternoon, [PII]. My name is [PII].
[AGENT][POSITIVE] Hi [PII], how can I help you?
[CUSTOMER][NEUTRAL] I'm calling regarding a claim that we filed with you guys for a member.
[AGENT][POSITIVE] Yeah, I'd love to help you with that claim today, Miss [PII], do you mind if I snag a quick callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what about a policy number?
[CUSTOMER][NEUTRAL] That'll be 02403458 M as in Mary, L as in Lima 8.
[AGENT][POSITIVE] Thank you, thank you.
[AGENT][NEUTRAL] One second while I get that policy pulled up for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, I appreciate your patience and if you could verify for me please your member's first and last name and date of birth.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] G vote.
[CUSTOMER][NEUTRAL] Date of birth would be.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect and I do see um [PII], am I saying that right, [PII] here?
[AGENT][NEUTRAL] Um, and you said you're looking at a claim. Do you know the claim number we're wanting to look at, or were you like me to search it by the date of service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, the account number will be [PII].
[AGENT][POSITIVE] Perfect and let me find that for you.
[AGENT][NEUTRAL] All right, and I do see that claim here. Would you just be able to verify for me the name of the provider on file of it?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] Oh no.
[AGENT][NEUTRAL] Oh, I'm so sorry. I guess the facility name.
[AGENT][NEUTRAL] I did say provider I'm sorry but the facility.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That'll be for South Florida Critical Care Services.
[AGENT][POSITIVE] Thank you so much I appreciate that.
[AGENT][NEUTRAL] So it looks like it's saying that the impatient calendar year maximum has been met.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] The provider
[AGENT][NEUTRAL] Um, and so I'm seeing.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] They have an inpatient calendar year benefit of $1500 granted that's just a verification of coverage and.
[CUSTOMER][NEGATIVE] There's a lack of
[CUSTOMER][NEUTRAL] Hi
[AGENT][NEUTRAL] I do show that they met their $1500 deductible $1500 benefit for the [PII] calendar year.
[CUSTOMER][NEUTRAL] OK, and that was paid to the hospital, correct? the benefits, the full amount?
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] So what I'm showing is like on your claim it was denied because it had already been met that somebody somewhere else in that calendar year she had used up that benefit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, I can take a look and if it was for your particular hospital, I can tell you, but if it was for another facility, I can't, unfortunately, I can't give any information on it.
[CUSTOMER][NEUTRAL] OK, and that will be for Baptist Hospital.
[AGENT][NEUTRAL] For Baptist Hospital and do you have that tax ID? I'm sorry, just so I can look it up real quick.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, I got um give me one second.
[CUSTOMER][NEUTRAL] I do have the NPI.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That'll be [PII].
[AGENT][NEUTRAL] You said that was the MPI. Do you have the tax ID? I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm so I should have caught that as soon as you said MPI but I didn't.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah I just
[AGENT][NEUTRAL] All right. So I'm not showing.
[AGENT][NEUTRAL] That matches the benefit where for where her inpatient benefits were used her $1500.01. I'm really sorry, um, but I can let you know that they were, they were exhausted previously in the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, no problem. And what would be the initiative your last name and a reference number for our call?
[AGENT][NEUTRAL] You bet you. The initial to my last name is [PII], and the reference number is my name [PII] and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it thank you very much for your help.
[AGENT][POSITIVE] Hey it's my pleasure thank you you take care.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye