AccountId: 011433970860
ContactId: 8d075baf-f452-4e84-a328-02483615dd6d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 761549 ms
Total Talk Time (AGENT): 192543 ms
Total Talk Time (CUSTOMER): 173803 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/8d075baf-f452-4e84-a328-02483615dd6d_20250519T17:05_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. This is [PII] calling from Pro offers to check the claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status too. um, what is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] The callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Thank you sir and then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] The patient
[CUSTOMER][NEUTRAL] Policy number is 021.
[CUSTOMER][NEUTRAL] 98427. And the patient's name is [PII]. And the date of date of birth is on.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me pull up that patient real quick.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, and then may I please have the
[AGENT][NEUTRAL] Data service and the charge amount.
[CUSTOMER][NEGATIVE] The date of service was wrong.
[CUSTOMER][NEUTRAL] [PII], the bill amount is $49,523.10.
[AGENT][NEUTRAL] OK, and then what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] It's $3,933.84.
[AGENT][NEUTRAL] OK, and then may I please get the facility name?
[CUSTOMER][NEUTRAL] Yeah, the facility name is HCF Florida Northwest Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim and I will be right back with you.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, Stu. This is Toy back with you again. I have the claim information for you.
[AGENT][NEUTRAL] The claim number is 356-9323.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim has been denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Mhm. May I know when it was received and when it was denied?
[AGENT][POSITIVE] Yes sir, let me look for you.
[AGENT][NEUTRAL] We received the claim on [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] And it was denied as need of primary, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And uh upon checking on my end, we have already uh
[CUSTOMER][NEUTRAL] [PII], the primary OB.
[CUSTOMER][NEUTRAL] Through the fax number. Oh sorry.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment. It was submitted to the
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Fax number is [PII].
[CUSTOMER][NEUTRAL] Um, 3659423. Is this correct?
[AGENT][NEUTRAL] Yes, that's, that's the correct fax number, but as of now we still have not received it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, OK, so we will send that ID to the same fax number, right?
[AGENT][NEUTRAL] That or you can send it electronically. I have a payer ID number if you would like that.
[AGENT][NEUTRAL] The payer ID number is 60801.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Yeah, OK. And we will send the primary will be again the fax number and the pay ID.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Mhm. Can I have the time, time number to send that?
[AGENT][NEGATIVE] We do not have a timely filing limit.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And yeah, OK. And uh can you check with another client?
[AGENT][NEUTRAL] Yes, sir. What is the member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] The policy number is already?
[CUSTOMER][NEUTRAL] The policy number is 021.
[CUSTOMER][NEUTRAL] 348
[CUSTOMER][NEUTRAL] 82.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the member's name and date of birth?
[CUSTOMER][NEUTRAL] The member's name is [PII], and the date of birth is on [PII].
[AGENT][NEUTRAL] OK, let me pull up [PII]'s policy real quick.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, and then what is the date of service for [PII] and the charge amount?
[CUSTOMER][NEUTRAL] Yeah, the date of service of um [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $27,354 even.
[CUSTOMER][NEUTRAL] And after the primary process, the bill amount is $2,482 even.
[AGENT][NEUTRAL] OK, and is it for the same provider?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Just a moment. No, it's for different provider. It's for North Austin Medical Center.
[AGENT][POSITIVE] Thank you, sir.
[AGENT][POSITIVE] OK dokey. I'm gonna look this one up and I'll be right back with you.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII] is part 2.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you [PII] for holding for me.
[AGENT][NEUTRAL] I've got the claim information for you.
[AGENT][NEUTRAL] The claim number is 3574051.
[AGENT][NEUTRAL] This claim was denied. We did receive an EOB, but the EOB did not have where the primary paid for the deductible copay or co-insurance, so we need the EOB that shows that the primary paid the deductible copay or co-insurance.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] That was applied.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, OK. May I know when the claim was received and it was denied?
[AGENT][POSITIVE] Yes, sir. Let me let get look that for you.
[AGENT][NEUTRAL] We received the claim on [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] Yeah, OK, to worry.
[CUSTOMER][NEUTRAL] And uh yeah, I do see the primary be which have the paid amount and the deductible.
[CUSTOMER][NEUTRAL] And we will send that to the fax number that you provided.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, the EOB that we received does not have the amount that was applied towards the deductible copay or co-insurance.
[CUSTOMER][NEUTRAL] Yeah, OK. Sorry, I have that. And we will send that to the fax number.
[AGENT][POSITIVE] OK, good.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, OK, and that's it. And can I get the call of hands?
[AGENT][NEUTRAL] Yes sir, you can use my name [PII] in today's date.
[CUSTOMER][POSITIVE] Yeah, OK, and thanks for that.
[AGENT][POSITIVE] You're very welcome. Is that everything I can help you with before we go?
[CUSTOMER][POSITIVE] Uh, no, nothing else, sorry. Thank you for asking.
[AGENT][POSITIVE] OK, well, you're welcome you have a good week and thank you for calling APL. Bye bye sir.
[CUSTOMER][POSITIVE] Yeah, you too. Have a good day, bye.