AccountId: 011433970860
ContactId: 7afc908d-6f27-440f-aa95-1271705cf666
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 943140 ms
Total Talk Time (AGENT): 303238 ms
Total Talk Time (CUSTOMER): 249685 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/7afc908d-6f27-440f-aa95-1271705cf666_20250116T20:08_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. I'm calling on behalf of provider office to know the claim status for the member.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] I'm sorry, [PII], your voice is going in and out.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] You did say your name is [PII]?
[CUSTOMER][NEUTRAL] Now, it is audible?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, that is, I can hear you for the moment, yes. And how can I help you today, [PII]?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hi. I'm calling regarding the claim status for the member.
[AGENT][NEUTRAL] OK, you have one patient that you're needing claim status for, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] Member's policy number is 01877139 M as in Mary, L as in Lima 7.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[AGENT][NEUTRAL] And any information on that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Claim number?
[AGENT][NEUTRAL] No member's name and date of birth.
[CUSTOMER][NEUTRAL] Sure. One moment.
[CUSTOMER][NEUTRAL] First name is [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you. Data service and total bill amount.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. Total bill amount?
[AGENT][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] Total bill amount is $5,696 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, and you already have the claim number, is that correct?
[CUSTOMER][NEUTRAL] No, I don't have the claim number. Give me a moment. I will check whether I have it uh in file or not.
[AGENT][NEUTRAL] Oh, I thought you, I can provide, um, yes, I can provide you the claim number.
[CUSTOMER][NEUTRAL] Sure, go ahead.
[AGENT][NEUTRAL] The claim number is 353-2631.
[AGENT][NEUTRAL] And this claim was denied?
[AGENT][NEUTRAL] And the reason for the denial is, yes, it states the place provide a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] The 93.
[CUSTOMER][NEUTRAL] OK. Needed primary. OK. Could you please provide me the received date, received date?
[AGENT][NEGATIVE] Yes, sir, and we have not received that.
[AGENT][NEUTRAL] [PII], denied on [PII].
[CUSTOMER][NEUTRAL] on [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. 2
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] I have. And could you please provide me the fax number to send the primary UOB?
[AGENT][NEUTRAL] Yes, you can send that to [PII]. Attention claims.
[CUSTOMER][NEUTRAL] OK. Could you check the fax number is [PII]?
[AGENT][NEGATIVE] No. Yeah, no, sir, that is not correct.
[AGENT][NEUTRAL] The fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. Thank you. And
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] For the document purpose, could you please provide me your name?
[AGENT][NEUTRAL] Yes, my name and today's date will be your call reference number. My name is [PII]
[AGENT][NEUTRAL] And [PII], once we have processed the claim or if you need a copy of this explanation of benefits, you may go to our portal at [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And print that.
[CUSTOMER][POSITIVE] OK, thank you. And I see, I have another one with me. Could you help me on the same?
[AGENT][POSITIVE] Yes, sir, you're welcome.
[AGENT][NEUTRAL] Is this for the same patients or a different patient?
[CUSTOMER][NEUTRAL] No, it is a different patient.
[AGENT][NEUTRAL] How many do you have, [PII]?
[CUSTOMER][NEUTRAL] Oh, I have the last one.
[CUSTOMER][NEGATIVE] This one is lost.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so just a moment for me to finish my portion of this claim that we just did.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And also on the next one, any information that I provide will be a verification of benefits and not a guarantee of payment. You will also use my name along with today's date as your call reference number for that one as well, and the same portal website would apply for this number. So what is the policy number?
[CUSTOMER][NEUTRAL] 02126470. M as in Mary, L as in Lima, number 7.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And I'm just gonna repeat that, excuse me. I'm gonna repeat that number back to you. 02126470. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII] and last name is [PII].
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And the date of service and total bill amount, please?
[AGENT][NEUTRAL] Hello [PII], are you still there?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEGATIVE] OK, I did not hear any of what you said. I wasn't able to hear you. You were not audible.
[CUSTOMER][POSITIVE] Now it is audible.
[AGENT][NEUTRAL] It is for the moment, yes, sir.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Hello, [PII]. Can you hear me?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What is the total bill amount for that data service?
[CUSTOMER][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] 101,351.43.
[AGENT][NEUTRAL] OK, say that one more time, please.
[CUSTOMER][NEUTRAL] 101,351.43.
[AGENT][NEUTRAL] 101,351.43. Is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what facility who is this claim for? What's the provider name?
[CUSTOMER][NEUTRAL] The facility name is HCA Florida Largo Hospital.
[AGENT][NEUTRAL] OK, so I do not have a claim for $101,351.43.
[CUSTOMER][NEUTRAL] Could you check on this one?
[CUSTOMER][NEUTRAL] 101337.67.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, just one moment please.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and you're giving me the date of service again is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, there's no claim on file for that data service.
[CUSTOMER][NEUTRAL] OK. One moment.
[CUSTOMER][NEUTRAL] But I received the correspondence from you.
[AGENT][NEUTRAL] You're giving me the date of service. Uh-huh. You're giving me date of service, you said a [PII]. Is that correct?
[CUSTOMER][NEUTRAL] But uh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment, I will check whether it is.
[CUSTOMER][NEUTRAL] Can I provide the claim number? Could you check on that?
[AGENT][NEUTRAL] Yes, sir, but I need for you to provide me the correct information before I can give you any information on a claim number. I need for you to be able to give me the correct dates of service.
[CUSTOMER][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] OK, give me a moment. I will check whether I provided the correct.
[CUSTOMER][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Could you check on this one? Uh,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so there is a claim on file for those dates of service and that total bill amount. The claim number is 3501271. Is that correct?
[CUSTOMER][NEUTRAL] 271, right.
[AGENT][NEUTRAL] Mhm. And yes, sir, that claim was denied. The reason for the denial states inpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] OK, could you please provide me the claim receive date?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] This claim was received on [PII] and it was processed and denied on [PII].
[CUSTOMER][NEUTRAL] OK. Your claim number is 3501271. And
[CUSTOMER][NEUTRAL] It is denied and the inpatient, right? OK.
[CUSTOMER][NEUTRAL] The charges is responsible to
[CUSTOMER][NEUTRAL] Patient or provider. Could you check on that?
[AGENT][NEUTRAL] We do
[AGENT][NEUTRAL] We do not determine patient responsibility, [PII], that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For a month.
[CUSTOMER][POSITIVE] OK. Thank you so much for the kind assistance on this.
[AGENT][POSITIVE] Yes, so you're very welcome. Yes, absolutely.
[CUSTOMER][NEUTRAL] Claim also. Yeah, I am done with all this. Could you please provide me the reference number for this one? Your name and today's date, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The same as the other one.
[AGENT][POSITIVE] That is correct, yes, sir. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much for the kind assistance on this call. Have a great day, [PII]. Have a great day. Bye-bye.
[AGENT][POSITIVE] I, I hope you have a nice day too, [PII], and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank.
[AGENT][POSITIVE] Wow