AccountId: 011433970860
ContactId: 90dadc64-753e-4601-bd33-444c14f8a26a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 419179 ms
Total Talk Time (AGENT): 155940 ms
Total Talk Time (CUSTOMER): 86864 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/90dadc64-753e-4601-bd33-444c14f8a26a_20250123T17:41_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider's office for claim status.
[AGENT][NEUTRAL] And you said your name is [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you're needing claim status, [PII]. Is that also correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Thank you and [PII], how many claims do you have to check status on?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] One claim.
[AGENT][NEUTRAL] OK. And what is that member's policy number, please?
[CUSTOMER][NEUTRAL] Member policy is 02431041.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]'s date of birth is [PII].
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] total charges are $72,205 even.
[AGENT][NEUTRAL] 72,0002, so I'm sorry, did you say 72,205, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the name of the facility that you're calling on behalf of?
[CUSTOMER][NEUTRAL] She see a Florida Embassy Hospital.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was received. The received date on the claim was [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It was processed the same date.
[AGENT][NEUTRAL] The claim number is 3,541,480.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] There was a benefit paid in the amount of $500.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] On single check.
[AGENT][NEUTRAL] 2018531
[AGENT][NEGATIVE] And there were 2 codes that were denied.
[AGENT][NEUTRAL] One of them states benefits are payable only if your major medical insurance provides benefits. If this claim is later paid by your major medical insurance, please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And the other one states that the major medical insurance provided full benefits, so there were no benefits payable.
[CUSTOMER][NEUTRAL] What is the remaining amount?
[AGENT][NEUTRAL] The $500 payment, it states with this check, the maximum benefit payable for this state of service has been met on the supplemental policy, the member's plan.
[CUSTOMER][NEUTRAL] Oh my [PII].
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] What is, uh, when was the check issued?
[AGENT][NEUTRAL] The date of the process date I gave you?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The date the claim was processed.
[CUSTOMER][NEUTRAL] Um, sorry, can you hear me? Hello?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] [PII], can you hear me?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah, uh, when was it issued?
[AGENT][NEUTRAL] The date of the process that it was processed that I gave you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um, sorry, I'm not able to hear you. It was issued on the same date, right, on the process date?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Can you please fax us the EOB?
[AGENT][NEUTRAL] Do you have access to the internet, Leo?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] We do have a portal in which.
[CUSTOMER][NEUTRAL] Can you please fax us the?
[AGENT][NEUTRAL] We do have a portal, Leo, that you can print the EOB from.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I can fax it, but I'm going to give you that website so that you can set up your profile that way you can have access to the EOBs.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, do you, uh, do the site need registration?
[AGENT][NEUTRAL] And the website for our portal is the it's.
[AGENT][NEUTRAL] You would need to register, yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the portal website that you would self-register on is secured. [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It.