AccountId: 011433970860
ContactId: 8c327ba7-00e1-46d9-8378-daf1f95737d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 467100 ms
Total Talk Time (AGENT): 162960 ms
Total Talk Time (CUSTOMER): 323173 ms
Interruptions: 8
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/8c327ba7-00e1-46d9-8378-daf1f95737d3_20250613T14:44_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Oh hi, good morning. So happy Friday how are you?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][NEUTRAL] Good, thank you. Yes, this is [PII] from Baptist Hospital of Miami, the Miami Cancer Institute. Yes, so I wanted to check with you guys. Um, we're sending a claim.
[AGENT][NEUTRAL] OK, understand.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] For this member, um, she has another insurance right now, but this state of service, I believe she was effective with you guys. So I just wanted to check if you received the claim.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I can check and see if we got that claim, Miss [PII]. Um, may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] Thank you. And what is the patient's policy number?
[CUSTOMER][NEUTRAL] OK. So I'm trying to see the number for you guys which is gonna be
[CUSTOMER][NEUTRAL] Oh, where is it at? APL.
[CUSTOMER][NEUTRAL] All right. For APL, it's going to be um
[CUSTOMER][NEUTRAL] Here it is this one here.
[CUSTOMER][NEUTRAL] Uh, get out of here. OK. 2, I'm sorry, 02137550.
[AGENT][NEUTRAL] OK. And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] OK, perfect. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] OK, so this one is [PII].
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, for the amount of 5,107.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see if we have it and that's [PII].
[AGENT][NEUTRAL] OK, I think it's gonna be this one. Let me pull the EOB on this one, OK.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Why can we get it so late?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] How is the weather down there today?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Well, you know what, it's very nice today. Probably in the [PII]. We got some nice rain yesterday, which kinda cooled down the, the heat, you know, but um beautiful. Everything is green and, and, and nice and today's been beautiful. How is it with you guys? Where are you in [PII]?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Um
[AGENT][NEGATIVE] No, we're in [PII] right now it's, uh, yeah, wet and moisty, not a good sign. It's like uh.
[CUSTOMER][NEUTRAL] Oh, [PII], OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Yeah, you don't wanna be.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] Not in [PII].
[CUSTOMER][NEUTRAL] But it's a rainy, it's a rainy season, you know, so you hopefully, you know, you'll get the rain, you know?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And then that will bring down the moisture and the humidity, yeah. It's, yeah, it's very bad down here. Yeah, it's very bad down in [PII], the humidity, but thank [PII], we've been getting rain, you know. We had a long drought back in April and May. Since June started, we've been getting rain like once or twice a week, which is, which, which keeps down everything and it's water in the grass. I don't, I don't have to water the grass or the flowers.
[AGENT][NEGATIVE] Yeah, the humidity here is awful.
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Oh, that's good.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] That's good, yeah
[CUSTOMER][POSITIVE] So, I'm thankful, yeah, I'm thankful for the rain. I hope you get some soon. Yeah. Mhm.
[AGENT][NEUTRAL] Oh, good. All right, so I did find a claim for um [PII]. It looks like we processed this back, uh, well, recently, we processed this on [PII], um, and the claim was denied. The reason for this denial is that um the outpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK, OK, so the benefits have been met. OK, [PII] and perfect. It's um, it's, uh, can I get a claim number please, [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Yeah.
[AGENT][NEUTRAL] Yes, sure. The claim number is 3,608,410.
[CUSTOMER][NEUTRAL] OK, so, and what is it she's terminated with you, right? What is the termination date with you guys because I see, I see another one on here.
[AGENT][NEUTRAL] She is.
[AGENT][NEUTRAL] OK, yes, um.
[AGENT][NEUTRAL] [PII] is when this one terminated. Mhm.
[CUSTOMER][NEUTRAL] [PII]. 0, you know, wait a minute. You know what? I think, well, hold on a second. Let me see. I see, I see, but we just billed you guys. I think there was a problem. Let me make sure I, I, I get that straightened out. So because I think she has two different policy numbers. We might have sent you the wrong one at some point. Hold on, let me make sure I gave you the right information. OK, hold on just signing with that.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So here's another number. Hold on, hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There were 2 numbers. OK, which one did I give you? OK, that one. So here's one, I hope I gave you the right one. this one here is um.
[CUSTOMER][NEUTRAL] 00, is this yours? Hold on, let me make sure.
[CUSTOMER][NEUTRAL] Nope, it's not yours, it's web TPA.
[CUSTOMER][NEUTRAL] So, anyway, uh, I just wanna make sure because I'm seeing a lot of different numbers on this patient in the system and I want to make sure. OK, here's one for chance um here's it. 0213. Is that the one I gave you? I'm I'm confused. Do I just give you 021, yeah, that's the one I gave you, right?
[AGENT][NEUTRAL] Mm, yeah, looks like.
[AGENT][NEUTRAL] 7550. Mhm.
[CUSTOMER][NEUTRAL] Alright, hold on, let's see which one is it that I have here that's trans maybe I would, OK, so maybe I did give you the right one. I just was, do you, did you see any other um plan in there for?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] For them
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, that's only, only that one policy number?
[AGENT][NEUTRAL] from his peal.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. Yeah, I just wanted to make sure because she has a lot of different plans in here and I see that some, some things have been terminated and then
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And this one, and then I see Transamerica. So I just want to make sure.
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Mhm. Yeah, this is the only one.
[CUSTOMER][NEGATIVE] But why did we bill you so late?
[CUSTOMER][NEGATIVE] I be these guys so late. I guess because it was billed to the wrong um I have no idea, but we just billed you and you guys did a good job in processing that so quick. We just billed it back in in in [PII]. Why did I bill you so late?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Probably.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Something happened here. OK. All right. Well, it it nevertheless, um, the patient um policy maxed out. So even if you guys, right, I guess if you guys had money, you would pay because you guys always pay our claims, no problem.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Correct, yes.
[AGENT][POSITIVE] Yeah. Correct, yes. Mhm.
[CUSTOMER][POSITIVE] I don't have any problems with you guys. You're one of my best players, but, um, because they don't, because they don't have any um fans. OK, perfect. Thank you so much, sir. Have a great weekend. Hope you get some rains to cut down that humidity pretty soon and um yes, we pray for that. Thank you so much. Take care.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] And thank you.
[AGENT][POSITIVE] Yeah. You're welcome. Have a good weekend, Ms [PII]. Thank you. Bye-bye. You're welcome. Bye.
[CUSTOMER][POSITIVE] OK. Yes, you too. Thank you. Mhm. Bye-bye. Bye-bye.