AccountId: 011433970860
ContactId: 6e36eb64-35da-4fe2-8ac4-a2edbfd8136b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 533219 ms
Total Talk Time (AGENT): 189985 ms
Total Talk Time (CUSTOMER): 216477 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/6e36eb64-35da-4fe2-8ac4-a2edbfd8136b_20250421T17:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, good, good afternoon, [PII], is that correct?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] 00 sorry, so sorry. OK, thank you [PII] for my name is [PII]. I'm calling from provider's office regarding claim status. Can you help me with that?
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Yes, I can help you with claim status. [PII]. May I please get your callback number just in case the call gets dropped?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you, ma'am. And then what is um the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK, date of birth is, uh, the patient's first name is [PII]. Date of birth is [PII], and the member's ID is [PII] [PII].
[AGENT][NEUTRAL] OK, let me pull up that policy real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, I have [PII] pulled up. Can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] OK, they service was.
[CUSTOMER][NEUTRAL] [PII] and the bill amount was.
[CUSTOMER][NEUTRAL] $24,063.46.
[AGENT][NEUTRAL] OK. And you said that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Of [PII]? OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Oh, just let me see.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do see here that the, you want to know how much pay the primary?
[AGENT][NEUTRAL] Yeah, what is the balance after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] It's 1300.
[AGENT][NEUTRAL] OK and then can you please give me the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] It's ACA Florida North Florida Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, Ms. [PII], and I will be right back with you. I'm gonna look up this claim information. Thank you, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, do you need the claim number by any chance?
[AGENT][NEUTRAL] Do you have the claim number?
[CUSTOMER][NEUTRAL] Yes, I do. I was able to find the claim on the portal. OK, the claim number is 35630302.
[AGENT][NEUTRAL] OK, what is that?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And that's 356-030-2.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a brief hold. I'm gonna pull this up for us and I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 12, 20034.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi, [PII]. This is [PII] back with you again. So looking at um that claim number 356-0302, I do, I do see that it was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, I do see here that we have sent you the EOB twice, first on [PII] to the fax number [PII] and also we send you on [PII]. Can you try to see if the claim is the.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, if the primary we have arrived because we have sent you multiple times.
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] Actually, that fax number that you gave me is not our fax number.
[CUSTOMER][NEUTRAL] I do have another one here that we have sent you to one that is [PII]. Is that your fax number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, that is the fax number and let me see if we've received it.
[CUSTOMER][NEUTRAL] OK, well, that one.
[CUSTOMER][NEUTRAL] OK, this one was sent on [PII]?
[AGENT][NEUTRAL] OK. Let me look.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, I do not see that we have anything received on [PII].
[CUSTOMER][NEUTRAL] OK, so did not arrive, OK.
[AGENT][NEUTRAL] Right, it didn't go through. Um, you might need to resend it again and let me give you the mailing or the uh payer ID number. Would you like that so you can send it electronically?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, just give me the fax number. Go ahead, the payer ID, the fax number is the billing address.
[AGENT][NEUTRAL] OK, the payer ID number is 60801.
[AGENT][NEUTRAL] The fax number is the [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And then the mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, just let me one second.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I see
[CUSTOMER][NEUTRAL] C
[CUSTOMER][NEUTRAL] OK. OK. Just to confirm, the pay ID is 60801. Fax number [PII] and the mailing address is [PII]. Is that correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct. You got it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, thank you. Can you tell me when did you deny the claim?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Uh, the claim was received on [PII] and was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Oh, OK, could you tell me the timely final?
[AGENT][NEUTRAL] We do not have one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is there any cover for the number?
[AGENT][NEUTRAL] You can use my name [PII], in today's date.
[CUSTOMER][POSITIVE] OK, thank you [PII] have a wonderful rest of your day bye bye and take care.
[AGENT][POSITIVE] You too, Ms. [PII]. That's everything I can help you with today?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, well, you have a wonderful rest of your week and thank you for calling APL.
[CUSTOMER][NEUTRAL] get it all up
[AGENT][NEUTRAL] Bye-bye, ma'am. You too.
[CUSTOMER][POSITIVE] Bye bye take care.