AccountId: 011433970860
ContactId: 64076367-9292-4d6b-92e1-e909c93a04b6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2030280 ms
Total Talk Time (AGENT): 451004 ms
Total Talk Time (CUSTOMER): 514143 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/64076367-9292-4d6b-92e1-e909c93a04b6_20250304T21:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] from provider's office to check on the claim status. How are you doing today?
[AGENT][POSITIVE] I'm doing well [PII] how are you doing today?
[CUSTOMER][POSITIVE] Yeah, I'm doing good as well. Thank you for asking.
[AGENT][NEUTRAL] Thank you sir. um, I can help you with the claim status, [PII], can you please give me your callback number?
[CUSTOMER][NEUTRAL] Oh, sure. It is [PII].
[AGENT][NEUTRAL] Thank you and then what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] All right. The patient's name is [PII], and the date of birth of the patient is on [PII]. The policy number is 10572777.
[CUSTOMER][NEUTRAL] M as in Mike, L as in Lima, number 4.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, thank you and then what is the data service for the um patient?
[CUSTOMER][NEUTRAL] Digital service is on [PII].
[AGENT][NEUTRAL] OK, and what is the charge amount?
[CUSTOMER][NEUTRAL] The charge amount is $11,031.26.
[AGENT][NEUTRAL] OK and then what was the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, just a second. I'm checking with that.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] It is $11,031.26.
[AGENT][NEUTRAL] OK, thank you and what is the name of the facility you're calling from, sir?
[CUSTOMER][NEUTRAL] It is HCA Florida West Side Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, [PII], while I look up this claim for you and I'll be right back.
[CUSTOMER][NEGATIVE] Yeah, sure. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you again. So looking on data service of [PII], I do not find the claim on file, sir.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][NEUTRAL] And that's for checking outside. We do have received
[CUSTOMER][NEUTRAL] NUB
[AGENT][NEUTRAL] From us.
[CUSTOMER][POSITIVE] Uh yes, that's right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please check with the claim number?
[AGENT][POSITIVE] Yes sir, please give that to me.
[CUSTOMER][NEUTRAL] Yes, it is 355-434-1.
[AGENT][NEUTRAL] OK, let me look that way.
[AGENT][NEUTRAL] OK [PII], I do see that the claim was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK. And may I have the received date and the denial date?
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] Let me check for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We received the claim on [PII] and the claim was processed on [PII].
[CUSTOMER][POSITIVE] OK. Thank you for that information. Just a second.
[CUSTOMER][NEUTRAL] OK. As per checking on our side, on last [PII], we have sent a primary EOB. Could you please check with that?
[AGENT][NEUTRAL] Yes, let me check this one.
[AGENT][NEUTRAL] OK, I do show that um it's claim number 3569409.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me check something real quick.
[AGENT][NEUTRAL] OK, I do show that that claim was paid.
[AGENT][NEUTRAL] Uh, with check number 2282025 and the amount of $250.
[AGENT][NEUTRAL] And it was paid to HCA Florida West Side Hospital.
[CUSTOMER][NEUTRAL] OK. Thank you for that information. And may I know whether it is single or bulk check?
[AGENT][NEUTRAL] It's a single check.
[CUSTOMER][NEUTRAL] Thank you. And may I also have the check mailing address?
[AGENT][NEUTRAL] Yes, it was mailed to [PII] that's in [PII].
[CUSTOMER][POSITIVE] OK, that's perfect time. Just a second. OK. May I know the check issue date?
[AGENT][NEUTRAL] Yes, the check issue date is [PII].
[CUSTOMER][NEUTRAL] OK. And may I also know the status of the check?
[AGENT][POSITIVE] It's outstanding.
[CUSTOMER][NEUTRAL] Whether it is cashed or not.
[AGENT][POSITIVE] It's outstanding it's just been sent.
[CUSTOMER][POSITIVE] Thank you for that information. And just a second.
[CUSTOMER][NEUTRAL] OK. Could you please fax the copy of EUB?
[AGENT][NEUTRAL] Yes sir, may I get your fax number?
[CUSTOMER][NEUTRAL] Yes, sure. Uh just a second. The fax number is [PII].
[AGENT][NEUTRAL] OK [PII], I'm gonna put you on a brief hold while I get that faxed together for you and I'll be right back sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on [PII].
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I've got that fax on its way to you now, sir.
[CUSTOMER][NEUTRAL] OK. Thank you. May I have the time to receive the fax?
[AGENT][NEUTRAL] You just have to give it a chance to get to you, sir. It's been sent.
[CUSTOMER][POSITIVE] Oh, OK. Thank you for that information.
[AGENT][POSITIVE] You're welcome sir.
[CUSTOMER][NEUTRAL] And could you
[CUSTOMER][NEUTRAL] Yes, and could you please help me to check on another claim status?
[AGENT][NEUTRAL] Yes sir, let me put my note in on this one and then we'll move on to the next one, sir.
[CUSTOMER][NEUTRAL] Yes, sure.
[AGENT][NEUTRAL] OK, [PII], what is the next patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] The next patient's name is [PII], and the date of birth of [PII] is on [PII].
[CUSTOMER][NEUTRAL] The policy number is 09135499 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] OK, thank you so much. Let me look at that one up.
[AGENT][NEUTRAL] OK, can you repeat that policy number to me one more time, sir?
[CUSTOMER][NEUTRAL] Yes, sure. It is 09135499 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, that policy number is not pulling up for me, sir, it's missing a digit. Do you see another number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Just a second. I'm double checking with that.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Could you please check with the number 01.
[CUSTOMER][NEUTRAL] 935-4999
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima. #8.
[AGENT][NEUTRAL] OK, let me look real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and the member's name is [PII] you said?
[AGENT][NEUTRAL] OK, I do find [PII] on this policy, yes.
[CUSTOMER][NEUTRAL] Um, right.
[AGENT][NEUTRAL] OK, and what is the date of service?
[CUSTOMER][POSITIVE] Thank you for that.
[CUSTOMER][NEUTRAL] OK, the date of service is on.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the charge amount?
[CUSTOMER][NEUTRAL] It is $25,429 even.
[AGENT][NEUTRAL] OK, and then what is the charges after the primary paid their part?
[CUSTOMER][NEUTRAL] Oh, just a, it is the same 25, 4 to 9 even.
[AGENT][NEUTRAL] OK, and then can you please give me the name of the facility?
[CUSTOMER][NEUTRAL] Sure. It is HCA Florida Memorial Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold again, [PII], so I can look up this claim for you and I'll be right back sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Alright [PII], thank you so much for holding for me. I do have the claim pulled up for you. The claim number is 355-0890.
[AGENT][NEUTRAL] The claim was received on [PII] and it was processed on [PII] and the claim was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][POSITIVE] OK. Thank you for that information. Uh just a second.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] OK. And as for checking on our side, on [PII], we have sent a primary EOB. Could you please check with that?
[AGENT][NEUTRAL] Yes, let me look.
[AGENT][NEUTRAL] We received um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, that's for a different client, sorry.
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] No sir, I have not received the EOB for that one.
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][NEUTRAL] OK. May I have the fax number to submit the primary UV.
[AGENT][POSITIVE] Yes sir, let me get that for you real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And may I have the time limit.
[AGENT][NEUTRAL] We do not have one.
[CUSTOMER][NEUTRAL] Thank you for that information. And could you please let me check on different claim status for different patient?
[AGENT][NEUTRAL] Yes sir, what is how many of these do you have sir?
[CUSTOMER][NEUTRAL] I do have 3 more.
[CUSTOMER][NEUTRAL] Claims.
[AGENT][NEUTRAL] OK. All right. What is the next um patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK. The patient name is [PII], and the date of birth of [PII] is on [PII].
[CUSTOMER][NEUTRAL] The policy number is 07931049 M as in Mike L as in Lima 7.
[AGENT][NEUTRAL] OK, let me, let me look that one up real quick.
[AGENT][NEUTRAL] OK and you said that was 0179?
[AGENT][NEUTRAL] 31049
[CUSTOMER][NEUTRAL] Uh, no, it is 07931049.
[AGENT][NEUTRAL] OK, that policy number is not pulling up for me. Do you see another number?
[CUSTOMER][NEUTRAL] OK, just a second. I'm double checking with that.
[CUSTOMER][NEUTRAL] OK. Could you please check with the policy number?
[CUSTOMER][NEUTRAL] 01931049.
[AGENT][NEUTRAL] OK, let me look.
[AGENT][POSITIVE] Yes, that's a good policy number.
[AGENT][NEUTRAL] And what is the date of service for [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The service is on [PII].
[AGENT][NEUTRAL] And the charge amount please?
[CUSTOMER][NEUTRAL] Charge amount is $5,717 even.
[AGENT][NEUTRAL] And then the charges after the primary paid their part?
[CUSTOMER][NEUTRAL] Um, just a second. I'm double checking with that. It is the same amount.
[AGENT][NEUTRAL] OK and then what is the name of the facility for [PII]?
[CUSTOMER][NEUTRAL] It is HCA Florida Aventura Hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm gonna put you on hold again. I will be right back, [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. I did find the claim. The claim number is 3570051.
[AGENT][NEUTRAL] The claim was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK. I have received it in the process.
[AGENT][NEUTRAL] I'm sorry, I'm sorry, let me give you the, the claim number. I'm sorry for this one is 3573823.
[CUSTOMER][POSITIVE] Thank you for that information. And we have received it and
[AGENT][NEUTRAL] I apologize.
[CUSTOMER][POSITIVE] Oh, no issue for that.
[CUSTOMER][NEUTRAL] OK. May I have received it and
[CUSTOMER][NEUTRAL] The denied date of the claim.
[AGENT][POSITIVE] Yes sir, let me look that up for you real quick.
[AGENT][NEUTRAL] OK, we received the claim on [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] Thank you. And as per checking on our side, on [PII], we have sent primary EOB. Could you please check with that?
[AGENT][NEUTRAL] Yeah
[AGENT][NEGATIVE] We still have not received the explanation of benefits from the primary showing where they paid their part.
[CUSTOMER][NEUTRAL] OK. It's been just sent on [PII] to the mailing address.
[AGENT][NEUTRAL] Oh well then it's probably not here yet.
[AGENT][NEUTRAL] Because you just sent it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, if that in case, may I have the turn around time to receive the primary UB.
[AGENT][NEUTRAL] Once we receive it, it takes 7 to 10 business days to process the claim.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And could you please help me to check on the next claim status?
[AGENT][NEUTRAL] OK, what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK. The patient name is [PII] and the date of birth is on [PII]. And the policy number is 02548736.
[AGENT][NEUTRAL] OK, let me look that one up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then what is the data service for Otis?
[CUSTOMER][NEUTRAL] The date of service is from [PII].
[AGENT][NEUTRAL] OK, and the charge amount, sir?
[CUSTOMER][NEUTRAL] The charge amount is $8150 even.
[AGENT][NEUTRAL] And then what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] OK. Just a second. I'm double checking with that. It is the same amount.
[AGENT][NEUTRAL] OK, and then what is the name of the facility for Otis?
[CUSTOMER][NEUTRAL] It is the same facility, HCA Florida Kendal Hospital.
[AGENT][NEUTRAL] Kindle, OK.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold again. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you [PII] for holding for me again.
[AGENT][NEUTRAL] So looking for this claim, the claim number is 3,551,860.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was denied for the same reason we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK. Thank you for that information. And may I also know the received date and process date of the claim?
[AGENT][NEUTRAL] Yes sir, we received the claim on [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] Thank you for that information. And just a second, I'm double checking with our end.
[CUSTOMER][NEUTRAL] OK, on.
[CUSTOMER][NEUTRAL] [PII], we have sent a primary EOB. Could you please check with that?
[AGENT][NEUTRAL] I do not see a primary EOB was received on that day, sir.
[CUSTOMER][NEUTRAL] Just a second
[CUSTOMER][NEUTRAL] As it has been sent to the same mailing address. OK. May I have the turnaround time to receive the primary UB?
[AGENT][NEUTRAL] Once we receive the primary EOB, it's the same turnaround time. It takes 107 to 10 business days to process the claim. That's standard, that's.
[AGENT][NEUTRAL] All claims
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for that information. And could you please
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] Yeah. Could you please help me to check on next claim status, which is the last one?
[AGENT][NEUTRAL] OK, can you give me the patient's name, date of birth, and policy number, please?
[CUSTOMER][NEUTRAL] Yes, sure. Uh, the patient name is [PII] and the date of birth is on March, oh, just a second.
[CUSTOMER][NEUTRAL] Yes, the patient name is [PII] and the date of birth is on [PII].
[CUSTOMER][NEUTRAL] The policy number is 01043757.
[AGENT][NEUTRAL] OK, let me look her up real quick for you.
[AGENT][NEUTRAL] OK, I've got [PII] pulled up. Can you please give me her date of service?
[CUSTOMER][NEUTRAL] OK. The date of service is on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, [PII] and then what is the charge amount please?
[CUSTOMER][NEUTRAL] It is $1,986.48.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold. I'll wait one more thing, may I get the um name of the facility for this one?
[CUSTOMER][NEUTRAL] It is Center Point Medical Center.
[AGENT][NEUTRAL] Center Point, OK, it's gonna be a brief hold again, [PII]. I'll be right back.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you [PII] for holding for me. So looking on [PII], I do not find a claim on file for that date of service for Miss [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Thank you for the information. And just a second, I'm double checking with our end.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Thank you for that information. And may I have the fax number to submit the primary UP along with the claim form?
[AGENT][NEUTRAL] Yes, that's the same number I gave you on the first, um, insured it's [PII].
[CUSTOMER][POSITIVE] Thank you for that. And there is no time refilling, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Thank you for that information. And that's all for today. May I have, uh, yes, may I have the call reference number for this call?
[AGENT][NEUTRAL] You're welcome, [PII].
[AGENT][NEUTRAL] Yes sir, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you. Thank you for your assistance. Have a great day.
[AGENT][POSITIVE] You too, [PII]. You have a wonderful night and thanks for calling APL bye bye sir.
[CUSTOMER][POSITIVE] Yeah, thank you, bye bye.