AccountId: 011433970860
ContactId: 8285bd8f-bb65-4d88-8b99-aa5a6f87cf2a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 417820 ms
Total Talk Time (AGENT): 197238 ms
Total Talk Time (CUSTOMER): 127542 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/8285bd8f-bb65-4d88-8b99-aa5a6f87cf2a_20250217T19:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi there, [PII]. My name is [PII] with University Hospital, and I'm calling to check the status of our claim.
[AGENT][NEUTRAL] OK, [PII], I'm happy to check on a claim. Uh, what is the patient's policy number?
[CUSTOMER][NEUTRAL] It is D for Delta 41203456.
[AGENT][NEUTRAL] Alright, so actually I can't pull it with that number, [PII], do you have the claim number or their name or social? I can check that way.
[CUSTOMER][NEUTRAL] I have the name, date of birth, mailing address.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But no social.
[AGENT][NEUTRAL] OK, let's just take a look by their name and see what we find. What's the last name?
[CUSTOMER][NEUTRAL] Actually, let me
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And also I'm gonna see if we have the insurance card. Um, the last name is um let me spell it [PII].
[AGENT][POSITIVE] Alright, thank you for that and then first name?
[CUSTOMER][NEUTRAL] First name is [PII].
[AGENT][NEUTRAL] And then what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Uh, that is [PII].
[AGENT][POSITIVE] OK, perfect. I got him up here.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, yeah, that number I'm looking at the insurance card and on the insurance card is listed as an employee ID.
[AGENT][NEUTRAL] Yeah, so their policy number, if you need it, I can give it to you. I have it here.
[CUSTOMER][POSITIVE] Oh great, yes please.
[AGENT][NEUTRAL] OK, so the policy number, [PII] is going to be 02.
[AGENT][NEUTRAL] 549747.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm. And what's
[CUSTOMER][NEUTRAL] I'll update this.
[AGENT][NEUTRAL] The data service we're looking for.
[CUSTOMER][NEUTRAL] Uh, it was [PII].
[AGENT][NEUTRAL] OK, and then fill them out.
[CUSTOMER][NEUTRAL] Billed amount was $22,957.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so it looks like we did excuse me, we did receive the claim.
[AGENT][NEUTRAL] Um, it looks like there was a benefit payment sent in the amount of $75. There was an ER procedure code and then a diagnostic. The diagnostic was denied. The benefit payment was only for the portion of the ER visit.
[CUSTOMER][NEUTRAL] Is that due to the uh type of plan?
[AGENT][NEUTRAL] So it looks like calendar maximum for diagnosis services has been met, so there was nothing additional payable on for that, the diagnostic part.
[AGENT][NEUTRAL] Yeah, and then it looks like.
[CUSTOMER][NEUTRAL] Met for the year?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh wow.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Calendar year maximum on diagnostic, yup, has been met.
[AGENT][NEUTRAL] And then it's uh
[CUSTOMER][NEUTRAL] For [PII], right?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] For the [PII], OK.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] And then the ER claim shows max for date of service met with this check, the maximum benefit payable for this date of service has been met.
[CUSTOMER][POSITIVE] Alrighty
[CUSTOMER][NEUTRAL] And uh that was for ER visits, uh, for [PII] this year. So the ER was max and the um.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Diagnostic.
[AGENT][NEUTRAL] Yeah, so the diagnostic was maxed for the year and then the ER visit was the max for that date of service.
[CUSTOMER][NEUTRAL] For the year ER.
[CUSTOMER][NEUTRAL] Your next.
[CUSTOMER][NEUTRAL] Alrighty and nothing else. I'm sorry, uh, do you show the check number?
[AGENT][NEUTRAL] Yes ma'am, uh, that check number is 202-7769.
[CUSTOMER][NEUTRAL] Bulk or single I guess single, right? Yeah.
[AGENT][NEUTRAL] It's a thing, yeah, it's a single.
[CUSTOMER][NEUTRAL] Any patient responsibility.
[AGENT][NEUTRAL] We're not able to advise on that that would be up to the facility or provider.
[CUSTOMER][NEUTRAL] And um that you all mail mail this claim is there issue date or mail this payment, excuse me.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Yes, absolutely. Let me get you that one moment.
[AGENT][NEUTRAL] Uh, so let's see, looks like claim was processed and paid on [PII].
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] So just this past Friday, and I can verify where that was sent to one moment.
[AGENT][NEUTRAL] Alright, so check was made out to HCA Florida University Hospital sent to [PII] in [PII].
[CUSTOMER][POSITIVE] Awesome, and may I have the claim number and receive date?
[AGENT][NEUTRAL] Mhm absolutely so claim number is going to be 3563883.
[AGENT][NEUTRAL] And it looks like claim was received on [PII].
[CUSTOMER][NEUTRAL] Alrighty and do you give call reference numbers?
[AGENT][NEUTRAL] Absolutely, that would be my name with my last initial, then today's date. My name again is [PII], that's [PII] My last initial to my name is [PII].
[CUSTOMER][POSITIVE] Awesome well thank you so much for your help, Ms. [PII] um I hope you enjoy the rest of your day.
[AGENT][POSITIVE] You too [PII] thanks for calling APL bye bye.
[CUSTOMER][POSITIVE] Thank you. Bye.