AccountId: 011433970860
ContactId: 61dde62a-d533-46b8-8908-ce36503e82cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1245520 ms
Total Talk Time (AGENT): 243733 ms
Total Talk Time (CUSTOMER): 341064 ms
Interruptions: 4
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/61dde62a-d533-46b8-8908-ce36503e82cc_20250328T18:46_UTC.wav
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[AGENT][POSITIVE] Good Afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, sir. This is [PII] calling for providers that network to check on a claim status.
[AGENT][NEUTRAL] Yeah, sure, I can assist you with claim status, Ms. [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK. And may I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yes, this is for the facility HCF Florida Mercy Hospital.
[AGENT][NEUTRAL] OK, nursey hospital.
[AGENT][NEUTRAL] All right. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, this is for the policy ID 01978557 M as in Mike, L as in Lima, number 7.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, the patient name is for.
[CUSTOMER][NEUTRAL] [PII] and the date of birth it is [PII].
[AGENT][POSITIVE] Alright, thank you.
[AGENT][NEUTRAL] And um may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes, the date of service, it is March, I'm sorry, [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] How much is the total charge?
[CUSTOMER][NEUTRAL] Yes, for the total bill amount is $13,000 I'm sorry, $13,715 even.
[AGENT][NEUTRAL] Yeah OK.
[AGENT][NEUTRAL] So that's uh [PII], the amount of $13,715 even, is that correct?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Mhm, yes, you're right.
[AGENT][NEUTRAL] OK. All right, and for future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] All right
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And it looks like we are waiting for the explanation of benefits from the primary insurance to continue the processing of this claim. We received this claim [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. One moment, please. Pro on [PII]. And I can see we have already submitted a submission and the submission was sent on um I'm sorry, it was submitted on [PII]. It was sent through fax.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, it didn't get here. What is the fax number that you send it to?
[CUSTOMER][NEUTRAL] Uh yes, it is to the fax number [PII].
[AGENT][NEGATIVE] That is the correct fax number, but we have not received it.
[CUSTOMER][NEUTRAL] Uh, I think it was mailed in, uh, it was sent through the mailing address actually, to the mailing address of [PII] I'm sorry, [PII]. Is that the correct uh correct mailing address?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That is the correct mailing address, yes.
[CUSTOMER][NEUTRAL] Uh, otherwise, should we wait because it was sent on [PII] since it was being sent through mail.
[AGENT][NEUTRAL] Mm. You can wait a little bit longer, but yeah, because we have not received anything just yet.
[CUSTOMER][NEUTRAL] Uh, in that case, maybe from 7, I'm sorry, 10 to 15 business days, will that be?
[AGENT][NEUTRAL] Mhm. Yeah. I would say if you send it on [PII], um, yeah, just wait, um maybe a week more just in case and then if it's not here by then, you can go ahead and resend it, but yeah, because um if it goes to regular mail, that's how it usually takes.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, uh, it will take to say 10 to 15 business days, right?
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][POSITIVE] To the max. Thank you so much. In that case, uh, may I have the call difference for this one, please?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] Thank you so much for that. In that case, thank you so much for assisting me and I do have a few more claim with me. Is that possible? Can you assist with me those also, please?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] So they're different members?
[CUSTOMER][NEUTRAL] Yes, uh, and before that, just give me a minute. Let me document those. Sorry for that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] um, and you don't need any other information on this one so I can make my notes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, bear with me, let me make a note on this one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh
[AGENT][POSITIVE] Yeah I'm ready whenever you are.
[CUSTOMER][NEUTRAL] Yes. For the next policy ID, uh, it is, uh, one moment. Yeah, it is 2272854.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, it was, uh, I mean, it is uh I'm sorry, [PII]. Date of birth [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Does he have any other names besides [PII]?
[CUSTOMER][NEUTRAL] Uh, is that [PII]?
[AGENT][POSITIVE] OK. Yes, thank you.
[AGENT][NEUTRAL] Alright, and what is today's service and the amount of the claim?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes, for the date of service, it is [PII] with the bill amount of 70,000.
[CUSTOMER][NEUTRAL] $536 even?
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] OK, so this one is the same as the previous one. We're waiting for the explanation of benefits from the primary insurance. Now, um, let me check and see, there is a pending claim. Let me see if this is your claim. Do you mind holding for me so I can pull this pending claim and see if this is yours. OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][POSITIVE] Please take your time.
[AGENT][POSITIVE] Thank you.
[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 and being patient for me. Yeah, it looks like it, it is the EOB that you sent in, um, so it is in line to be processed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And uh may I know how much, uh, when it was been received, please?
[AGENT][NEUTRAL] On the [PII].
[CUSTOMER][NEUTRAL] [PII]. And uh for this one also, it will take maximum of 7 to
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 14 business days.
[CUSTOMER][NEUTRAL] Then this is it, is that right?
[AGENT][NEUTRAL] It's 7 to 14 business days for it to process. Mhm, yes.
[CUSTOMER][POSITIVE] Oh, that's great.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] One moment, please.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] And in that case, uh, for this one also is that the same same number?
[AGENT][NEUTRAL] Um, I'm not sure what claim number it's gonna have.
[CUSTOMER][NEUTRAL] Uh, may I have the, I mean, the claim number that?
[AGENT][NEUTRAL] Because it hasn't been processed yet. Mhm.
[CUSTOMER][POSITIVE] OK, got it. Thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you. One moment, slowly.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And I do have one more claim with me. Is that possible? Can you assist with me those also, please?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, yes, um, bear with me just a second. And you don't need any other information on this one, correct? I need to make my note. OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh yes. Yes.
[CUSTOMER][POSITIVE] Wow
[CUSTOMER][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Wow
[AGENT][POSITIVE] I'm ready whenever you are.
[CUSTOMER][NEUTRAL] Mhm. Uh, just a moment, please. Uh, one moment.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So the next
[CUSTOMER][NEUTRAL] Uh, the next policy ID it is actually one moment.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah. For the next policy ID it is 025.
[CUSTOMER][NEUTRAL] 0, I'm sorry, 02505608.
[AGENT][NEUTRAL] OK. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes. The patient name it is uh [PII] I'm sorry, [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK. What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes, for the date of service, it is uh [PII], I'm sorry, it is [PII] with the bill amount of $4,389 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, let me pull this EV one moment.
[AGENT][NEUTRAL] I'm waiting on the system, OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so we processed the claim on [PII] and the claim was denied. The reason for this denial is the benefit maximum for the date of service has been met.
[CUSTOMER][NEUTRAL] OK. Uh, does that mean, uh, the member need to update the CUP? Is that regarding the COP line?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] No, it means that she already used all her benefits for that date of service.
[CUSTOMER][NEUTRAL] So does that mean it is non-covered under the members uh plan?
[AGENT][NEUTRAL] No, it means she already used all her benefits for that date of service.
[AGENT][POSITIVE] She has maxed out the benefits.
[CUSTOMER][POSITIVE] OK, got it. Thank you so much for that.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] One moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much. And I think we have submitted.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Another submission on [PII].
[CUSTOMER][NEUTRAL] [PII] in order to update that information.
[CUSTOMER][NEUTRAL] Uh reconstruction actually. It was sent on [PII].
[AGENT][NEUTRAL] I have no other claims for that data service or nothing pending.
[CUSTOMER][NEUTRAL] Mhm. So can we take more 10 to 15 business days from that date in order to process, uh, if, if, if there's no claim, we can submit the recitation again, right?
[AGENT][NEUTRAL] Well, we have not received any other claims. Um, the only one that we have received is the one that we processed and that.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm