AccountId: 011433970860
ContactId: a276be4d-9090-4f78-b958-e5840f0f66c9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 977830 ms
Total Talk Time (AGENT): 280006 ms
Total Talk Time (CUSTOMER): 252401 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/a276be4d-9090-4f78-b958-e5840f0f66c9_20250108T14:02_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office to check the claim status.
[AGENT][POSITIVE] OK, well I'll be more than happy to assist you with the claim status, [PII], and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] In one moment.
[CUSTOMER][NEUTRAL] Only 2.
[AGENT][NEUTRAL] OK, and may I have a good contact number in case we're disconnected and the the first member's policy number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the policy number is 024788777.
[AGENT][NEUTRAL] Thank you for that. And are both um claims for the same member or they're different members?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Are both of the claims for the same member or it's different members?
[CUSTOMER][NEUTRAL] No different numbers.
[AGENT][NEUTRAL] OK, and can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, my name is uh [PII] and the last name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII].
[AGENT][NEUTRAL] Thank you, and the total bill amount?
[CUSTOMER][NEUTRAL] Yeah, bill amount is $11,506 even.
[AGENT][NEUTRAL] Thank you for that. And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, it's it's a Florida Mercy Hospital.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we received the claim on [PII].
[AGENT][NEUTRAL] That claim number is 349.
[AGENT][NEUTRAL] 90
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] 349.
[AGENT][NEUTRAL] 9045.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII]
[CUSTOMER][NEUTRAL] What is the process date?
[AGENT][NEUTRAL] On [PII], the claim was processed and denied.
[AGENT][NEUTRAL] Requesting to, um, requesting for a more detailed explanation of benefits that shows the amounts that were paid.
[AGENT][NEUTRAL] To the deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, we have already sent the primary UOB. Did you receive it or not?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] The, the
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] So on [PII], we received the um corrected claim.
[CUSTOMER][NEUTRAL] It could bring the
[AGENT][NEUTRAL] The claim number is 354.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] One moment. Could you repeat it again? Could you repeat this slowly, please?
[AGENT][NEUTRAL] 1
[AGENT][NEUTRAL] On [PII], we received the corrected claim.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] The claim number is 341.
[AGENT][NEUTRAL] I'm sorry, 354.
[AGENT][NEUTRAL] 1502.
[CUSTOMER][NEUTRAL] 354
[CUSTOMER][NEUTRAL] 1504, right?
[AGENT][NEUTRAL] 1
[AGENT][NEUTRAL] 1502.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] It was denied.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider.
[AGENT][NEUTRAL] $1,585.49.
[CUSTOMER][NEUTRAL] One moment, please. One moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, uh, sorry.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, when it was paid.
[AGENT][NEUTRAL] Hold on, let me go back.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what is the allowed amount?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So the benefit for outpatient is $2000 per calendar year?
[CUSTOMER][NEUTRAL] $2000 right?
[AGENT][POSITIVE] Correct, per calendar year.
[CUSTOMER][NEUTRAL] OK, what is the uh paid amount? Is the paid amount is correct?
[AGENT][NEUTRAL] Again, the paid amount is $1,585.49.
[CUSTOMER][NEUTRAL] Sorry, could you repeat it again? 1000?
[AGENT][NEUTRAL] $1,585.49.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any patient responsibility or deductible amount?
[AGENT][NEUTRAL] And we don't determine patient responsibility because we're not the major medical insurance provider.
[CUSTOMER][NEUTRAL] OK. Uh, is this a bulk amount or check check amount?
[CUSTOMER][NEUTRAL] Sorry, it is this bulk amount single amount?
[AGENT][NEUTRAL] It was a single check?
[AGENT][NEUTRAL] Did you need the checking information?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Alright, so the check is number 201.
[AGENT][NEUTRAL] 852 1.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] It was issued on [PII].
[CUSTOMER][NEUTRAL] OK. Can you fax the OB?
[AGENT][NEUTRAL] To peel
[AGENT][NEUTRAL] Sure. What's a good fax number for you?
[CUSTOMER][NEUTRAL] 866
[CUSTOMER][NEUTRAL] 463745-3
[AGENT][NEUTRAL] And does that need to be attention, Sam?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what's the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah, uh, can I get the caller, sorry, could you, could you spell out your name, please?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK. Uh, is the claim number is, uh, different for the claims or the same?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Call, sorry, call reference number.
[AGENT][NEUTRAL] The call reference number will be the same for the entire call.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, one moment. Let me go to another claim.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, and the claim number, uh, member ID number is
[CUSTOMER][NEUTRAL] 0187713
[CUSTOMER][NEUTRAL] 9 ML 8.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] that's what I.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] Yes, date of birth is uh [PII].
[AGENT][NEUTRAL] Thank you for that. And again, all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, date of service is uh [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] Yes, bill amount is $34,468.75.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] right
[AGENT][NEUTRAL] And can you repeat the total bill, I'm sorry?
[CUSTOMER][NEUTRAL] Yes, uh 34,000.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $468.75.
[AGENT][NEUTRAL] And 75. OK, thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So I'm showing I received the claim on, well, hold on, let me, OK.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, can I get the received date?
[AGENT][NEUTRAL] Are you needing the claim for the original claim or the corrected claim?
[CUSTOMER][NEUTRAL] Corrected claim. We have already sent the primary EOB.
[AGENT][NEUTRAL] OK, so we received.
[AGENT][NEUTRAL] We received the corrected claim on [PII].
[AGENT][NEUTRAL] The claim number is 354.
[CUSTOMER][NEUTRAL] I was able to get
[AGENT][NEUTRAL] 1500.
[CUSTOMER][NEUTRAL] 3,541,500.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim, a total of 2000.
[AGENT][NEUTRAL] 120. OK.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] When it was paid?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is the paid amount?
[AGENT][NEUTRAL] 2000.
[AGENT][NEUTRAL] $124.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] And 16 cents.
[CUSTOMER][NEUTRAL] OK. Uh what is the allowed amount?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] The benefit is up to $5000 per calendar year.
[CUSTOMER][NEUTRAL] $5000 right? All allowed amount.
[AGENT][NEUTRAL] Per calendar year.
[CUSTOMER][NEUTRAL] OK. Is this single uh single amount or bulk amount?
[AGENT][NEUTRAL] It was sent as a single check?
[AGENT][NEUTRAL] Did you need the check number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So it's 201.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] 8520.
[CUSTOMER][NEUTRAL] But I'm
[CUSTOMER][NEUTRAL] When it was issued?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, can you fax the ADOB?
[AGENT][POSITIVE] Yes, I can fax the EOB to you.
[CUSTOMER][NEUTRAL] Yeah, uh, yeah, uh, previously we have already
[CUSTOMER][NEUTRAL] So, as required for the fax, but I, we did not receive it till now.
[AGENT][NEUTRAL] I'm sorry. You, you say you have received the fax or you haven't?
[CUSTOMER][NEUTRAL] No, we haven't.
[AGENT][NEUTRAL] OK, well, I'm gonna, I'm sending them to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And [PII], was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, uh.
[CUSTOMER][NEUTRAL] Can I get the call reference number? Do you have the fax number, right?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and the uh call reference number is the same for the whole call. It will be my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][POSITIVE] OK. Thank you so much for providing the information, and have a nice day. Thank you.
[AGENT][POSITIVE] Thank you also and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] You.