AccountId: 011433970860
ContactId: 9dc1e131-708c-41f6-9542-3eb392a03d5d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 783479 ms
Total Talk Time (AGENT): 176200 ms
Total Talk Time (CUSTOMER): 276284 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/9dc1e131-708c-41f6-9542-3eb392a03d5d_20250424T15:05_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider office for checking claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status. I didn't catch your name. What was that?
[CUSTOMER][NEUTRAL] It's [PII], and last name first initial is [PII].
[AGENT][NEUTRAL] OK [PII], I can help you with claim status and do you have a good callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you and you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Mhm, um.
[CUSTOMER][NEUTRAL] That is 01867080 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, and the patient name and date of birth?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the date of service and bill charges?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Data services [PII] and total charge amount is $2,0086 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. uh, and who is the provider?
[CUSTOMER][NEUTRAL] Sorry, you're asking for for provider name?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, the provider is [PII].
[AGENT][NEUTRAL] I is this a facility claim or a I've got several claims for that date different claims so is this a facility claim or a?
[AGENT][NEUTRAL] Uh, doctors.
[CUSTOMER][NEUTRAL] This is, this is a facility I am.
[AGENT][NEUTRAL] Facility claim, OK.
[CUSTOMER][NEUTRAL] It's a facility yeah Boca Rashan Regional Hospital, uh, Boca Boca Anpe Services.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah, I'm not, uh, I'm not seeing a facility claim on file. I've got pathology, radiology.
[AGENT][NEUTRAL] Physician.
[CUSTOMER][NEUTRAL] Boca Rashan Regional Hospital.
[CUSTOMER][NEUTRAL] Billing address?
[CUSTOMER][NEUTRAL] And facilities book and service.
[AGENT][NEUTRAL] Um, what was the bill amount again?
[CUSTOMER][NEUTRAL] 2086. The, the secondary uh insurance.
[CUSTOMER][NEUTRAL] And remaining invoice balance is 1,097 22 cents.
[AGENT][NEUTRAL] OK, the only, the only date of service or [PII].
[AGENT][NEUTRAL] This is for Boca anesthesia service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] This
[AGENT][NEUTRAL] Is that right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me see
[AGENT][NEUTRAL] Looks like we needed the explanation of benefits, primary explanation of benefits.
[CUSTOMER][POSITIVE] Primary, yes, yes, so we resubmitted uh primary you will be uh on.
[CUSTOMER][NEUTRAL] Mm, [PII], so I'm calling for uh resubmitted claim status.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, looks like, OK, I did find it. It's we received it 42125, process 42125.
[CUSTOMER][NEUTRAL] Like
[AGENT][NEUTRAL] And it looks like we made a payment of 65052.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, uh, this is paid. May I know the allowed amount?
[AGENT][NEUTRAL] It this is a secondary policy. We don't have a loud amount.
[CUSTOMER][NEUTRAL] OK, sure. May I know the paid amount?
[AGENT][NEUTRAL] 650, 52.
[CUSTOMER][NEUTRAL] $650.52.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Is there any patient responsibility?
[AGENT][NEUTRAL] We don't determine patient responsibility since we're secondary.
[CUSTOMER][NEUTRAL] OK, no, um, may I know the mode of payment, uh, whether it is check or EFT.
[AGENT][NEUTRAL] Single check, check number 22040009.
[CUSTOMER][NEUTRAL] Check, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the issue date?
[CUSTOMER][NEUTRAL] Same, OK. And may I know the um pay address?
[AGENT][NEUTRAL] 421, 25.
[CUSTOMER][NEUTRAL] Have
[AGENT][NEUTRAL] Um, let me check.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Sorry, [PII].
[AGENT][NEUTRAL] 4159.
[CUSTOMER][POSITIVE] 4159. OK, thank you so much.
[CUSTOMER][NEUTRAL] Mhm. May I know the claim number?
[AGENT][NEUTRAL] Claim number is, hold on.
[AGENT][NEUTRAL] 3591937
[CUSTOMER][NEUTRAL] OK. May I know your good name, please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, [PII], and, uh, I have no UB. Please write UB to my fax it attach me to my name.
[AGENT][NEUTRAL] What's your facts?
[CUSTOMER][NEUTRAL] Uh, my fax number is [PII].
[AGENT][NEUTRAL] OK, I'll get that faxed over. It just takes about 5 minutes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And, uh, [PII], I have another patient. Uh, could you help me with that?
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] Yeah, thank you so much.
[CUSTOMER][NEUTRAL] And um both patients have only one call reference or different call reference number?
[AGENT][NEUTRAL] Uh, one call reference.
[CUSTOMER][POSITIVE] Only one, OK, thank you so much.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, what's the other policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. The member ID is 202042067 [PII].
[AGENT][NEUTRAL] OK, and the patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII]. It's [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and bill charges?
[CUSTOMER][NEUTRAL] Yeah, data service is [PII] and charge amount is $470 even.
[AGENT][NEUTRAL] Uh, we received that on [PII], process 72524.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A maximum benefit payable dollar amount for this day of service has been met.
[CUSTOMER][POSITIVE] Maximum benefits, dollar amount.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] A dollar amount has been met.
[CUSTOMER][NEUTRAL] OK. May I know how many dollars uh for this data service?
[AGENT][NEUTRAL] 500.
[CUSTOMER][NEUTRAL] $500. OK. For this data service we have $470 right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And secondary insurance have $125 OK.
[CUSTOMER][NEUTRAL] So pending balance is $125.
[AGENT][NEUTRAL] Yeah, it was met on another date of service, so it says $500 per calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, $500 for [PII].
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] It is how many stages? Dollar amount?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, $500 for current year, right? Uh, so how many stages uh patient made?
[AGENT][NEUTRAL] They've already met it on a different date of service.
[AGENT][NEUTRAL] For a different provider.
[CUSTOMER][NEUTRAL] OK, may I know the fax number?
[CUSTOMER][NEUTRAL] no
[AGENT][NEUTRAL] Fax number [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm. Yeah.
[CUSTOMER][NEUTRAL] OK. May I know the mailing address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much. May I know the claim number?
[AGENT][NEUTRAL] 348-435-8.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much and.
[CUSTOMER][NEUTRAL] OK. It's all fine. Um.
[CUSTOMER][NEUTRAL] May I know the call reference number for both clients?
[AGENT][NEUTRAL] It's my name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK, [PII], thank you so much for calling, uh, giving details and have a great day bye bye.
[AGENT][POSITIVE] OK, thanks for calling APL you too, bye.