AccountId: 011433970860
ContactId: 9950cd9b-ab5f-4bc1-a9be-5fe8e0d3e89b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1221760 ms
Total Talk Time (AGENT): 238215 ms
Total Talk Time (CUSTOMER): 298927 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/9950cd9b-ab5f-4bc1-a9be-5fe8e0d3e89b_20250303T19:08_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hey, it's [PII] calling from the provider office to know the claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Can I please get your callback number, sir, just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII].
[AGENT][NEUTRAL] Thank you. And then what is um the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] The patient name is [PII]. Date of birth, [PII]. And policy number is 02002986 M as in Mike, L as in Lima, 8.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, let me pull up that policy real quick.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, and what is the date of service and the charge amount please?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Date of service is [PII] and total charge amount is $7,849 even.
[AGENT][NEUTRAL] OK, and then what is the charge?
[AGENT][NEUTRAL] primary insurance pay their part?
[CUSTOMER][NEGATIVE] Your voice is breaking.
[AGENT][NEUTRAL] What is the charge amount after the insurance paid their part?
[CUSTOMER][NEUTRAL] Just wait a minute. I'll let me check.
[CUSTOMER][NEUTRAL] I mean.
[CUSTOMER][NEUTRAL] [PII] is
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello I'm here.
[CUSTOMER][NEUTRAL] Can you just explain me clearly?
[CUSTOMER][NEUTRAL] What do you actually want?
[AGENT][NEUTRAL] I'm sorry, I asked for the.
[AGENT][NEUTRAL] Mount after the primary insurance their part.
[CUSTOMER][NEUTRAL] The balance, OK, is $609 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you having a network problem because your voice is breaking too much?
[AGENT][NEUTRAL] OK, and then,
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] No sir, I'm not. Are you? I can hear you good.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] OK and then um.
[AGENT][NEUTRAL] What is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It's HCA Florida Kendal Hospital.
[AGENT][NEUTRAL] OK. Let me look that up.
[AGENT][NEUTRAL] HCA Florida Kendall.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look at this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Alright, thank you for holding for me so looking on data service of.
[AGENT][NEUTRAL] [PII]. I do not find the claim on file for the insured.
[CUSTOMER][NEUTRAL] OK. Just wait a minute.
[CUSTOMER][NEUTRAL] In my system is showing you need a copy of a primary EOB.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] And we have sent you a primary UB via fax and mail also.
[CUSTOMER][NEUTRAL] Did you receive it?
[AGENT][NEUTRAL] OK, let me look.
[AGENT][NEUTRAL] Let me look and see what day did you send it?
[CUSTOMER][NEUTRAL] Just wait a second.
[CUSTOMER][NEUTRAL] We have sent on [PII] and [PII].
[CUSTOMER][NEUTRAL] And on [PII].
[CUSTOMER][NEUTRAL] 3 times we did sent.
[AGENT][NEUTRAL] OK, on.
[AGENT][NEUTRAL] Right, looking on this, uh.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Insured
[AGENT][NEUTRAL] I do not see anything since after [PII].
[CUSTOMER][NEGATIVE] And you didn't receive the primary UP.
[AGENT][NEUTRAL] Right. I do not see anything after [PII].
[AGENT][NEUTRAL] Let me see if it's on a different policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Sorry to disturb you. Can you just check with this policy number? I have another policy number here.
[AGENT][NEUTRAL] I'm checking right now with the one that's active. Let me see if it's on there.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look this one up. I'll be right back.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, I'm back, so looking on uh policy number 246-7658.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] I show that the claim was submitted.
[AGENT][NEUTRAL] And again, the
[CUSTOMER][NEUTRAL] right
[AGENT][NEUTRAL] EOB from the primary insurance was not submitted with the claim.
[CUSTOMER][NEUTRAL] 93.
[AGENT][NEUTRAL] Under this claim number or sorry, under this policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'll send you once again.
[CUSTOMER][NEUTRAL] Can you just provide me your fax number?
[AGENT][NEUTRAL] Yes, sir. It's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you, can you just help me with the two more claims?
[AGENT][NEUTRAL] Yes, what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, so, just wait a second. I'll provide you.
[CUSTOMER][NEUTRAL] Hey, are you ready?
[AGENT][POSITIVE] Yes, I'm ready.
[CUSTOMER][NEUTRAL] Yes. The patient name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is
[CUSTOMER][NEUTRAL] [PII]. And the policy number is 1578531 M as in Mike L as in Lima 7.
[AGENT][NEUTRAL] OK, let me look that policy up real quick.
[AGENT][NEUTRAL] OK, and then what is the date of service for this policy?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] The total charge amount is $3,426 even.
[AGENT][NEUTRAL] OK, and then what is the amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] I need
[CUSTOMER][NEUTRAL] It's $500 even.
[AGENT][NEUTRAL] OK, and then what is the name of the facility please?
[CUSTOMER][NEUTRAL] It's HCA Florida West Side Hospital.
[AGENT][NEUTRAL] OK I'm gonna put you on a brief hold while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. um, I found the claim it's 347-2119.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And the claim was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, per checking in my system, we have already sent you the primary EOB for time.
[AGENT][NEGATIVE] Mm, not showing that we have received it.
[CUSTOMER][NEUTRAL] OK. So should I send it again?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Just wait a second.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Should I send the primary you be on that fax number which you have given me first?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, sure. Thank you so much. I have one more last claim. Can you just help me with it?
[AGENT][NEUTRAL] Yes, can I get the name, date of birth, and policy number, please?
[CUSTOMER][NEUTRAL] Yeah, sure. Just wait a second.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hey, are you ready?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[CUSTOMER][NEUTRAL] And policy number is 01866994 M as in Mike, L as in Lima 8.
[AGENT][NEUTRAL] OK, let me look up this policy real quick.
[AGENT][NEUTRAL] OK, and what is the date of service for Polly?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] And the charge amount please?
[CUSTOMER][NEUTRAL] It's $17,909 even.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] It's $500 even.
[AGENT][NEUTRAL] OK, and the name of the facility, please?
[CUSTOMER][NEUTRAL] It's HCA Florida Northwest Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look this one up for you, [PII] and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you [PII] for holding for me. So I did find this claim is 3,503,950 and the claim was denied for the same reason we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. We will send you.
[CUSTOMER][NEGATIVE] In this also we have sent you the primary UB multiple times. You didn't receive it?
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII].
[AGENT][POSITIVE] You're welcome, [PII]. I hope you have a wonderful day and we thank you for calling APL.
[CUSTOMER][NEUTRAL] Yes. Can I have a call, can I have a call reference number?
[AGENT][NEUTRAL] Yes, you can use my name and today's date.
[CUSTOMER][NEUTRAL] OK. It will be same for all the accounts?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome. You too, thanks for calling APL. Bye bye.
[CUSTOMER][POSITIVE] Have a great day.