AccountId: 011433970860
ContactId: 76c8c627-bea7-4de7-95d9-973d40d3e67c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 548359 ms
Total Talk Time (AGENT): 157017 ms
Total Talk Time (CUSTOMER): 339002 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/76c8c627-bea7-4de7-95d9-973d40d3e67c_20250313T18:29_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, good afternoon. I'm not sure, um, what happened to the phone. I didn't get a chance to press anything. Is this, um, I'm calling from the pro I don't know, it could be my phone. It it's crazy. Sorry. Um, I wanted to, yes, ma'am. I wanted to ask about a claim I'm calling from the provider's office, claim status, please.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] OK, well, I
[AGENT][POSITIVE] Yes, ma'am. I can definitely help you with the claim status. May I have your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And [PII], may I have a good contact number for you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes. Um, one second. Let me go back over here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, one second, that.
[CUSTOMER][NEGATIVE] Oh come on.
[CUSTOMER][NEGATIVE] Um, yes, we're having issues today with our system. Phone, everything is on a whack.
[AGENT][POSITIVE] Oh, take your time.
[AGENT][POSITIVE] It's OK, take your time.
[CUSTOMER][NEUTRAL] Yeah, here it is now.
[CUSTOMER][NEUTRAL] So sorry about that. OK, um, 1480364.
[CUSTOMER][NEUTRAL] Let's see what's going on.
[AGENT][NEUTRAL] Here we go. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, ma'am. It is um [PII]. Uh date of birth [PII].
[AGENT][POSITIVE] Thank you for that.
[AGENT][NEUTRAL] And all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Yes. Um,
[CUSTOMER][NEUTRAL] This one here is for
[CUSTOMER][NEUTRAL] Uh one second.
[CUSTOMER][NEUTRAL] What's going on here? OK, um, I'm gonna ask you on this one first. It's a kind of old one, data service [PII].
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Let's see what happened here.
[CUSTOMER][NEUTRAL] What did they
[AGENT][NEUTRAL] OK, here we go. And what is the, what's the total bills on there?
[CUSTOMER][NEUTRAL] It was for um.
[CUSTOMER][NEUTRAL] Uh, I'm sorry, 60,00911.
[CUSTOMER][NEUTRAL] I think you guys paid on this claim. I'm not sure.
[AGENT][NEUTRAL] 60,000911. OK, this is it.
[AGENT][NEUTRAL] 29. And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Don't know what. Sure. Baptist Hospital of Miami.
[AGENT][NEUTRAL] OK. So yes, ma'am, I am showing the claim here. It looks like we received it on
[AGENT][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Uh, that claim number is 342.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 264 9.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim a total of $500 to the provider.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so you pay the $500. I, I know I saw 500, but the patient has another um spoke and he's uncovered. OK. So, um, we built this, uh, there's another insurance that she has for the foundation. So I think they messed up here. I'm gonna try to make sure, but I did see a $500.
[CUSTOMER][NEUTRAL] And that's all you guys pay for that um for that code, right? For those codes for outpatient?
[AGENT][NEGATIVE] Not so much the coal for the benefit that was used. Yes, the max is $500.
[CUSTOMER][NEUTRAL] Oh, the benefits. Yes, the benefits, correct. Yes. OK, perfect. I just wanted to um to make sure that you guys are the ones that paid it. um, cause I see, right, I see where they billed another claim and then they bill it to a foundation and then they bill it to the patient as well. So I need to get this all straightened out perfect.
[AGENT][NEUTRAL] Oh, yes, ma'am.
[CUSTOMER][NEUTRAL] So sorry. Thank you so much. And then I have this one now, [PII], um, that's the real one that I was calling about. It was for this report. It was, um, I'm doing a report, all these reports, 60 this one here is for [PII] and the data service is [PII], please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And the bill amount, United Choice Plus $78,0094. I was wondering if you, you guys received that claim yet?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] This may be it. I'm checking for you. Hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] then this one here. What is this one here.
[AGENT][NEUTRAL] OK, yeah, this is it.
[AGENT][NEUTRAL] So we received this claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 35699974.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], that um we paid out on the claim to the provider, let's see, a total of $500.
[CUSTOMER][NEUTRAL] Oh, so you paid $500. Was there a check number, please?
[AGENT][NEUTRAL] Sure, let me see, hold on one moment.
[AGENT][NEUTRAL] Alright, so the check number is 2030493.
[CUSTOMER][NEUTRAL] I'm sorry, I'm sorry, 2 I'm sorry, can you say that again? 203.
[AGENT][NEUTRAL] Sure, 203.
[AGENT][NEUTRAL] 0493.
[CUSTOMER][NEUTRAL] OK, perfect. So, um, because I see here, so that's the benefits because it's the same thing as the other one,
[CUSTOMER][NEUTRAL] We have 6, we, we have a balance pending from you guys as secondary for $6350 and you paid $500 because that's the benefit that they have for this category, right? For this um.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. I just wanted to make sure because we're gonna bill whenever we got your payment, we're gonna build the foundation because she has a co-pay foundation that um will pick up certain jobs. I don't know if they're gonna pick it up, but we wait for your um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For your uh payment, and then we will go ahead and uh bill her for that. Um, is there a way that you can, you can fax me or email me a copy of the EOB so I have it on hand so I can send it to the [PII] prayer if it's not a problem for you?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Sure. It's not a problem at all. Um, did you need it for both claims or just this last claim here?
[CUSTOMER][POSITIVE] Uh, you know, you're so on the ball more than me today. Let me get it for both, please.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm glad somebody is up there today, not me.
[CUSTOMER][NEUTRAL] It's one of those days, yes.
[AGENT][NEUTRAL] OK, so I got this one and the 2nd 1. OK, and then what's a good fax number for you?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure, sure, thanks. [PII]. I'm sorry, I'm giving you my phone number. I'm sorry. I'll start all over. It's gonna be [PII] soon, I hope. [PII].
[CUSTOMER][NEUTRAL] I'm telling you [PII].
[AGENT][NEUTRAL] And do I need to put attention, [PII]?
[CUSTOMER][POSITIVE] Yes, please, [PII] I appreciate your your help.
[AGENT][NEUTRAL] So [PII]
[AGENT][NEUTRAL] Oh, you're very welcome. Just to confirm the fax number [PII], I'm sorry, [PII] attention, [PII].
[CUSTOMER][POSITIVE] Yes, please. I appreciate it so much.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] You're very welcome. Well, I'll go ahead and send the um explanation of benefits over to you now. Was there anything else I can help with?
[CUSTOMER][NEUTRAL] Yes, please, [PII], do you know the effective date so because we have another big claim that is pending to be paid by primary and we're gonna send the balance to you. Is it um they're still active with you guys?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, um, this policy, the policy has been active since [PII] and it's still active.
[CUSTOMER][NEGATIVE] No. OK.
[CUSTOMER][POSITIVE] Still active? OK, perfect. Great. Thank you so much. I really appreciate your help today. You have a great day. Thank you for your support.
[AGENT][POSITIVE] Thank you, [PII], you also.
[AGENT][POSITIVE] You're welcome and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Yes, you're welcome. Thank you too. Bye-bye. Bye-bye.
[AGENT][NEUTRAL] Oh God