AccountId: 011433970860
ContactId: 70e3cc85-49cc-4636-a163-ae5552b9dcba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 618359 ms
Total Talk Time (AGENT): 244708 ms
Total Talk Time (CUSTOMER): 171320 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/2025/02/28/70e3cc85-49cc-4636-a163-ae5552b9dcba_20250228T14:15_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from provider's office.
[CUSTOMER][NEUTRAL] To check the gender claim status.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you with claim status. What is the callback number, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number, please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 02431041.
[AGENT][NEUTRAL] And the patient's name and date of birth, please, [PII]?
[CUSTOMER][NEUTRAL] [PII], uh [PII].
[AGENT][POSITIVE] All right, thank you. And it would be my pleasure to assist you with that claim status for [PII]. What is the date of service?
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] [PII]. Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is the bill amount, please?
[CUSTOMER][NEUTRAL] $72,205.
[AGENT][NEUTRAL] And the facility name, please?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hessa, Florida, Mercy Hospital.
[AGENT][NEUTRAL] Thank you, [PII]. Excuse me, [PII], we did receive that claim on [PII], processed and paid.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 1216.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Pray on
[AGENT][NEUTRAL] Processed and paid on [PII].
[CUSTOMER][NEUTRAL] On the same, uh, received on [PII] and paid on [PII].
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is the reason?
[AGENT][NEUTRAL] The it we paid the maximum benefit payable for that data service of $500.
[AGENT][NEUTRAL] And that went to HCA Florida Mercy Hospital.
[CUSTOMER][POSITIVE] My exam benefits, sir.
[AGENT][NEGATIVE] Yeah, that did exhaust the benefit for that calendar day with that payment of $500.
[CUSTOMER][NEUTRAL] Of $500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How much the member met for what date of service?
[AGENT][NEUTRAL] 500
[AGENT][NEUTRAL] $500. The benefit amount is $500 per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Per day $500 per day is only $500.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] For which claim it got denied, it was paid.
[AGENT][NEUTRAL] On that claim number 3,541,480.
[CUSTOMER][NEUTRAL] 3,541,480.
[AGENT][NEUTRAL] Or, yes, sir.
[CUSTOMER][NEUTRAL] This is a case. So this is a delayed case. So the students are good exhaustion.
[CUSTOMER][NEUTRAL] So this is the denied claim number, right?
[AGENT][POSITIVE] That is the paid claim number. There's no denial. We paid the maximum benefit payable.
[CUSTOMER][NEUTRAL] Can I know the pay details?
[AGENT][NEUTRAL] It was a single paper check.
[AGENT][NEUTRAL] Check number. OK.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, check number?
[AGENT][NEUTRAL] Check number 2018531.
[AGENT][NEUTRAL] And it was issued on [PII].
[CUSTOMER][NEUTRAL] What is the paid amount?
[AGENT][NEUTRAL] $500.
[CUSTOMER][NEUTRAL] What is the allowed amount?
[AGENT][NEUTRAL] $500 is the benefit amount.
[AGENT][NEUTRAL] No, we don't reprice claims.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] There's no repricing of the pro in our processing of the claim, so we pay the benefit amount of $500 per calendar day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, what is the check issue date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is everything on [PII]?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Whatever the dates you gave me, it's all came under [PII], right?
[AGENT][NEUTRAL] The the check was issued on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] To which mailing address the claim and the check was issued?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Be your
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, it's [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Can you please, can you please send me the UOB?
[AGENT][NEUTRAL] The our EOBs are obtainable on our provider portal at [PII].
[AGENT][NEUTRAL] And that's a simple self registration portal.
[CUSTOMER][NEUTRAL] Can you please repeat the portal once again?
[AGENT][NEUTRAL] Yes sir, it's secured. It's [PII]
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sorry, sorry, just a second. Just a second, please. [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. And then?
[AGENT][NEUTRAL] [PII]. So it is secured. Amub that you got it and all you do to have that uh to register is use the tax ID number.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] And the patient's account number in box [PII] on the UBO4, and you'll have instant access to EOBs, claim status and claim submission.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And if you're going to that website, I can assist you with that account.
[CUSTOMER][NEUTRAL] OK. Can I get the call reference number?
[AGENT][NEUTRAL] Call reference number is my name and today's date, and I spell my name [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] First initial last name, [PII].
[CUSTOMER][NEUTRAL] And today's date
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes. Yes, sir.
[CUSTOMER][NEUTRAL] Oh, OK, it's ma'am, I think. I'm not, sir, please.
[AGENT][POSITIVE] Yeah, I'm sorry.
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] Uh, no, you gave me uh much information. Thanks for the information. Bye. Take care. Bye-bye. Have a great day.
[AGENT][POSITIVE] It's been my pleasure to assist you, [PII]. You have a great day as well, and thank you for calling APL. Take care.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.