AccountId: 011433970860
ContactId: 61db0356-2e2d-4797-83e9-dd9c61dce835
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 324329 ms
Total Talk Time (AGENT): 114824 ms
Total Talk Time (CUSTOMER): 129542 ms
Interruptions: 2
Overall Sentiment: AGENT=1.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/61db0356-2e2d-4797-83e9-dd9c61dce835_20250326T15:55_UTC.wav
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[AGENT][POSITIVE] Morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and I'm the billing manager for the orthopedic Surgery Center of Palm Beach County in [PII].
[CUSTOMER][NEUTRAL] And I need to check on the status of a secondary billing.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you with that claim status, Miss [PII]. What is a good callback number?
[CUSTOMER][NEUTRAL] [PII] and that's my cell.
[AGENT][NEUTRAL] Thank you. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] 00945668
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][POSITIVE] And it would be my pleasure to assist you with that claim status for [PII]. What is the date of service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the bill amount.
[CUSTOMER][NEUTRAL] This primary was Blue Cross. Um, the bill amount was $6,338.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what was the name of the facility if you don't mind please?
[CUSTOMER][NEUTRAL] The orthopedic Surgery Center of Palm Beach County.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Um, the doctor's bill would have been orthopedic center of Palm Beach County. So you would have got a doctor bill and the facility bill.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right. Well, we can check both of those claim status for you. um, but you're needing the facility claim, correct?
[CUSTOMER][NEUTRAL] Yes, I need the facility one.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] So I am showing that we received that claim for the facility.
[AGENT][NEUTRAL] On
[AGENT][NEUTRAL] [PII] and processed on [PII].
[AGENT][NEUTRAL] Now, with this secondary policy benefits are payable only if the major medical insurance provides benefits. So according to the
[CUSTOMER][NEUTRAL] Yeah, Blue Cross did.
[AGENT][NEUTRAL] OK, so let me get this claim pulled up, bear with me.
[AGENT][NEUTRAL] Because according to the denial, there was nothing applied to the deductible, co-pay or co-insurance.
[AGENT][NEUTRAL] And that is why
[CUSTOMER][NEUTRAL] On the Blue Cross.
[AGENT][NEUTRAL] Yeah, let me just pull this up and check.
[CUSTOMER][NEUTRAL] Oh no, no, no, no, uh, wait a minute, I can, I can pull that note too.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, uh, it looks like the pre-certification authorization or notification was absent.
[CUSTOMER][NEUTRAL] Wait just one second.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't even know how this one got.
[CUSTOMER][NEUTRAL] Dropped to the secondary.
[CUSTOMER][NEUTRAL] I have no idea because you're absolutely right. Blue Cross didn't pay anything.
[CUSTOMER][NEUTRAL] It was.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, the, there was no pre-certification. They said I know there is, but they said there wasn't, so I have to call the doctor's office and start all over again.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Would that, would you like to clean them?
[CUSTOMER][POSITIVE] I'm so glad it's Friday.
[AGENT][NEUTRAL] Is it Friday? Is it?
[CUSTOMER][NEUTRAL] I'm sorry. No.
[AGENT][NEUTRAL] I wish, I wish.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEGATIVE] Oh, you just got me excited for nothing.
[CUSTOMER][NEUTRAL] Uh, I have to, I know it, I know it. I pretend a lot.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] I understand.
[AGENT][NEUTRAL] Oh, do I ever understand?
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so very much and I'll see what I can do about this.
[AGENT][NEUTRAL] Now, if you do receive an updated EOB showing a deductible copay or co-insurance, please resubmit it so we can.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Um, reconsider it for benefits.
[CUSTOMER][POSITIVE] Absolutely. Thank you so much.
[AGENT][NEUTRAL] And did you want that claim number?
[CUSTOMER][NEUTRAL] Uh, no, I don't think so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I don't think I'm gonna need that one.
[AGENT][POSITIVE] All right. Well, it has been such a pleasure to assist you.
[CUSTOMER][POSITIVE] But thank you. Have, have a great rest of the week.
[AGENT][POSITIVE] I hope you do too and I hope you have a great weekend.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you, [PII]. Take care. Bye-bye.
[CUSTOMER][NEUTRAL] Uh-huh. Bye-bye. Uh, you too. Bye-bye.