AccountId: 011433970860
ContactId: 6d549a8b-d695-4113-94af-e0d1dcddce2a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 679359 ms
Total Talk Time (AGENT): 145943 ms
Total Talk Time (CUSTOMER): 168598 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/6d549a8b-d695-4113-94af-e0d1dcddce2a_20250116T21:04_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] calling from the provider's office to check on a claims information.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim. Can you please give me your callback number, sir?
[CUSTOMER][NEUTRAL] The callback number is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, sir. Thank you for that. And then what is the patient's name?
[CUSTOMER][NEUTRAL] First name is [PII]. Last name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is the policy number please for the patient?
[CUSTOMER][NEUTRAL] Policy number is 01973045.
[AGENT][NEUTRAL] OK, let me pull in the policy.
[AGENT][NEUTRAL] OK and then what is the date of service?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] OK, and then what's the charge amount please?
[CUSTOMER][NEUTRAL] Charge amount is $45,602.61.
[AGENT][NEUTRAL] Thank you. And then what is the charges after the primary insurance pay their part?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, it's the same charges, ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what is the name of the facility you're calling?
[CUSTOMER][NEUTRAL] The primary.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, uh
[CUSTOMER][NEUTRAL] The facility's name is Stewart Florida Medical Center.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, [PII], I'm gonna put you on hold. I'm gonna look that claim up for you and I'll be right back, sir.
[CUSTOMER][NEUTRAL] do.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you again. So looking um for [PII] on data service [PII], there's not a claim on file for that amount.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and just a moment.
[AGENT][NEUTRAL] And I looked and there aren't any other active policies for him.
[CUSTOMER][NEUTRAL] Mhm. And uh may I know the member is active on the data service.
[AGENT][NEGATIVE] So no
[AGENT][NEUTRAL] The policy lapsed on [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII], right? but.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] So the patient is not active on the data service.
[AGENT][NEUTRAL] The date of service was September, so he would have been active September, October, November, December, yeah, for 3 months before it lapsed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] All right. And uh
[CUSTOMER][NEUTRAL] Chest.
[CUSTOMER][NEUTRAL] Can you please help me with one more claim?
[AGENT][NEUTRAL] Yes sir, what is the um member's name?
[CUSTOMER][NEUTRAL] Uh, just a moment. And may I know your name, please?
[AGENT][NEUTRAL] Yes, my name is [PII]
[CUSTOMER][NEUTRAL] Thank you, [PII], and just a moment, let me pull up the next claim.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] The next claim number, uh sorry, uh, do you need the member's name?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] The next claim number is
[CUSTOMER][NEUTRAL] Sorry, uh, the member's name is [PII]. First name is [PII]. Last name is [PII].
[CUSTOMER][NEUTRAL] I'm.
[AGENT][NEUTRAL] OK, and then what is the um member's date of birth?
[CUSTOMER][NEUTRAL] Firstly, uh, the date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is the member's policy number, please?
[CUSTOMER][NEUTRAL] The policy numbers are 1491583 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Thank you. And then what is the date of service?
[CUSTOMER][NEUTRAL] The data service is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then what's the charge amount please?
[CUSTOMER][NEUTRAL] $10,66.11.
[AGENT][NEUTRAL] OK, and the charge after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] It's the same, ma'am.
[AGENT][NEUTRAL] OK, and is it for the same facility?
[CUSTOMER][NEUTRAL] It's for the different facility. It's Palmetto Stewart Palmetto General Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold again. I'll be right back, [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you, so I did find the claim.
[AGENT][NEUTRAL] The claim number is 3533018.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was reported on [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And it was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK, and just a moment.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And may I know your name and the card reference number?
[AGENT][NEUTRAL] Yes, you can use my name, [PII], yes, and today's date.
[CUSTOMER][NEUTRAL] Sorry
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you, doctor. Thank you for your patience and your confirmation. Have a great day.
[AGENT][POSITIVE] You too [PII] you have a good day and thank you for calling APL.
[AGENT][NEUTRAL] Bye-bye, sir.
[CUSTOMER][NEUTRAL] Bye bye.