AccountId: 011433970860
ContactId: 930a34da-2637-4d07-aa7c-58da44aedb96
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 504739 ms
Total Talk Time (AGENT): 118246 ms
Total Talk Time (CUSTOMER): 163672 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/930a34da-2637-4d07-aa7c-58da44aedb96_20250212T17:47_UTC.wav
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[AGENT][NEUTRAL] For calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII], just like my daughter's name.
[CUSTOMER][NEUTRAL] May I have the initial or your last name?
[AGENT][NEUTRAL] [PII],
[CUSTOMER][NEUTRAL] OK, I'm calling from South Miami Hospital. I'm calling to see if you guys received the bill from us.
[AGENT][POSITIVE] I'd be happy to assist with the claim. May I have your first name please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] And if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] 02462030 ML 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And the date of service for the claim?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Data service for the claim?
[CUSTOMER][NEUTRAL] Oh, I'm sorry, uh, [PII] for 9 $9,999,983.
[AGENT][POSITIVE] Thank you for that information. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Um, I do see we have, uh, we received the claim. It was denied. Let me.
[AGENT][NEGATIVE] For the review why it was denied.
[CUSTOMER][NEUTRAL] When did you receive it?
[AGENT][NEUTRAL] Um, one moment.
[AGENT][NEUTRAL] Claim was received on [PII]. Claim denied on [PII].
[CUSTOMER][NEUTRAL] Now is that claim number 351-873-2?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] No, 351-119-6.
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] 3, I'm sorry, what was it again? 3?
[AGENT][NEUTRAL] 351-119-6.
[CUSTOMER][NEUTRAL] And why did the 9?
[AGENT][NEGATIVE] That's not even.
[AGENT][NEUTRAL] No, one moment.
[AGENT][NEUTRAL] 927.
[AGENT][NEUTRAL] 127
[AGENT][NEUTRAL] 24
[AGENT][NEUTRAL] 311.
[CUSTOMER][NEGATIVE] Oh, I see. The beds were exhausted.
[AGENT][NEUTRAL] It looks like there was a mismatch with the claim, the claim we received in the EOB didn't match.
[CUSTOMER][NEUTRAL] What you mean it didn't match?
[AGENT][NEUTRAL] So the EOB that we received has the patient's name on it, but the claim form submitted has a different name and the patient name, but it has the correct date of birth.
[CUSTOMER][NEUTRAL] That's weird. Let me see. Oh no.
[CUSTOMER][NEUTRAL] You sure it's not the guarantor? When was it that you received that one you said in September?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] In December we'll send you another one.
[CUSTOMER][NEUTRAL] On [PII], let me look at the claim that went out.
[AGENT][NEGATIVE] I don't see that we received another one.
[CUSTOMER][NEUTRAL] Yeah, I says that's weird. I says, so [PII].
[CUSTOMER][NEUTRAL] Something, something, a little bit.
[AGENT][NEUTRAL] [PII], right, was on the claim, but it has the right date of birth with the wrong person, but the EOB has the right name.
[AGENT][NEUTRAL] Of the person, but we couldn't process it because.
[CUSTOMER][NEUTRAL] Right. No, yeah, you don't have the, have that. Let me see about, let me see the one we sent in December.
[AGENT][NEGATIVE] The claim wasn't right.
[CUSTOMER][NEUTRAL] Because why is it coming on a roof?
[CUSTOMER][NEUTRAL] That's very weird.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] there
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] And then I have it, uh, oh dear it's [PII].
[CUSTOMER][NEGATIVE] Oh what the heck? Where is that coming from?
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Because the patient is brown then, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, everything in the records, everything says [PII].
[CUSTOMER][NEUTRAL] Why would they?
[CUSTOMER][NEGATIVE] That it's totally wrong.
[CUSTOMER][NEUTRAL] I don't know why, because I have it on the.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Uh, who's done that.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEGATIVE] Let me, I don't understand it.
[AGENT][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] [PII], the subscriber says [PII].
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] You know back into the encounter.
[CUSTOMER][NEUTRAL] And there's something different in the encounter, but
[CUSTOMER][NEUTRAL] Is she the policy holder, do you know?
[AGENT][NEUTRAL] I don't know who the [PII] is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me have a, um, I think I have your.
[AGENT][NEUTRAL] Oh, I'm sorry, [PII] is the mother. I'm sorry.
[CUSTOMER][NEUTRAL] Ah.
[AGENT][NEUTRAL] So they put the mother's name with the dependent's date of birth.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] When, but we need um, his name to be on the claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEGATIVE] Unbelievable.
[CUSTOMER][NEUTRAL] All right. Um, let me have a reference for, I mean, um, the fax number.
[AGENT][NEUTRAL] 877
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] You guys don't give references, right?
[AGENT][NEUTRAL] It's just my name [PII] last initial [PII], and the date and time of the call.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Why they put that name in there? I have to figure out how to take that off.
[CUSTOMER][POSITIVE] All right, honey, thank you.
[AGENT][POSITIVE] Thank you for calling APL you have a good day.
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][NEUTRAL] Bye bye.