AccountId: 011433970860
ContactId: 81875f38-679a-4200-a6bb-adf3e7af0611
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 665679 ms
Total Talk Time (AGENT): 177077 ms
Total Talk Time (CUSTOMER): 166072 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/81875f38-679a-4200-a6bb-adf3e7af0611_20250606T15:41_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on the claim status.
[AGENT][NEUTRAL] Sure, I can assist you with claim status, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII].
[AGENT][NEUTRAL] OK, may I have the name of the facility you're calling from for my notes?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, uh, this is HCA Florida West Side Hospital.
[AGENT][NEUTRAL] OK, thank you. May I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, the patient policy number will be 1343156 M Mary L Lima 8.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, the name will be [PII].
[AGENT][NEUTRAL] OK. And may I have the date of birth? Mhm.
[CUSTOMER][NEUTRAL] And the date of birth, yeah.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, perfect. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, the date of service will be uh of [PII].
[AGENT][NEUTRAL] How much is the total charge?
[CUSTOMER][NEUTRAL] Yeah, the total charges will be of $7,426.12.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Thank you. And can you repeat the date of service one more time?
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Right, let me see if I can find this claim for you and for future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's see, [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Really.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, we received that claim on [PII], process on [PII], and the claim was denied. The reason for this denial is that outpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, sorry, could you please explain that?
[AGENT][NEUTRAL] Outpatient benefits for the calendar year has been met. She has lost her benefits.
[CUSTOMER][NEUTRAL] OK. Bes has been exhausted, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] May I know it has been exhausted as uh uh through dollars of visits?
[AGENT][NEUTRAL] That will be the dollar value.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment please um.
[CUSTOMER][NEUTRAL] Uh, so how much dollars will be allowed?
[AGENT][NEUTRAL] OK, let me look at the benefits and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let's see, so the calendar year maximum on this policy is 1500.
[CUSTOMER][NEUTRAL] OK. So how it has been completely met?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, thanks for that. And is that OK to wait for one minute? I'm I'm just checking on it.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So how much dollar amount has patient met excluding the claim? Do you have that information?
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Can you repeat?
[CUSTOMER][NEUTRAL] OK. It has, OK, no problem. Uh, do you have the claim number?
[AGENT][NEUTRAL] Yes, um, the claim number is 3582406.
[CUSTOMER][NEUTRAL] Uh, could you please once again repeat me that?
[AGENT][NEUTRAL] Yes, that is 3582406.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. May I have the uh
[CUSTOMER][NEUTRAL] Your name and the call reference number?
[AGENT][NEUTRAL] We don't have a reference number, so you can use my name in today's date. My name is [PII]. That's [PII], last initial [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Is that OK to send the uh U be through fax?
[AGENT][NEUTRAL] Um, we're not needing the EOB. The claim has been denied. We already received the EOB.
[CUSTOMER][NEUTRAL] No, I just want
[CUSTOMER][NEUTRAL] I, I just want from my side. Could you please send us a copy of the new video fax?
[AGENT][NEUTRAL] Oh, you need the EOB by fax. OK, yes, and what is the fax number?
[CUSTOMER][NEUTRAL] Yeah, the fax number will be [PII].
[CUSTOMER][NEUTRAL] Um [PII].
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] Is it gonna be to your attention, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and that's [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Ms. [PII]. Yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I just want to know the uh patient type.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, patient type, uh, it has been processed or, uh, processed as in network or out of network?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical. There's no network, we follow primary.
[CUSTOMER][NEUTRAL] OK, do you have like PTO or HMO like that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, because we're not a major medical Miss [PII].
[CUSTOMER][NEUTRAL] OK. Do you know which responsibilities for uh for patients or uh providers?
[AGENT][NEUTRAL] I'll have to check the primary EOB and you can see that under the primary EOB because we're not the primary.
[CUSTOMER][POSITIVE] OK, thanks for that and have a good day.
[AGENT][NEUTRAL] Yeah, so Ms. [PII], is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][POSITIVE] No, thanks for that and have a good day.
[AGENT][POSITIVE] Mm, you as well. Thank you for calling APL. Bye-bye, Mr. [PII].
[CUSTOMER][NEUTRAL] Mhm.