AccountId: 011433970860
ContactId: a277c43a-b84b-4c4f-a6d0-8b9f4714092e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 478059 ms
Total Talk Time (AGENT): 178534 ms
Total Talk Time (CUSTOMER): 127138 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/a277c43a-b84b-4c4f-a6d0-8b9f4714092e_20250501T15:39_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, this is [PII] calling from the provider office. Could you please help me with the claim status?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the claim status, [PII], and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I'm having one claim.
[AGENT][NEUTRAL] Alright, and may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, sure. The contact number is [PII], and there is no extension to directly.
[AGENT][NEGATIVE] Uh oh, the phone's kind of breaking up there. If you're, if you're giving the policy number, I didn't hear you.
[CUSTOMER][NEUTRAL] The policy number is 01792040 M as in Mike L as in Lima H.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] I the member name is [PII], and also her 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.
[AGENT][NEUTRAL] And may I have the date of service and the total bills for the claim you'd like me to take a look at with you?
[CUSTOMER][NEUTRAL] Yes sure. The service is [PII] with the billed amount of
[CUSTOMER][NEUTRAL] Yeah. The bill amount of $1,722 even.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] Alright, and [PII], do you mind if I place you on just a brief hold while I locate the claim?
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, what's happening now.
[AGENT][NEUTRAL] I'm gonna do this one first 3487509 because that one was paid 3820.
[AGENT][NEUTRAL] Do you see if there's any other ones.
[AGENT][NEUTRAL] 509.
[AGENT][NEUTRAL] And then 820.
[AGENT][NEUTRAL] OK to the. Oh, OK, OK, OK, OK, that's the difference. Hold up, slow down.
[AGENT][NEUTRAL] This is insured, so that's the only one that matters to them because they're the provider and I can't give the insured so that answers the question. OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah, I'm here.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait, and can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Assure the providers offices JLR Medical Group, Anastasia Florida, and also called the US Anesthesia Partners of Florida.
[AGENT][NEUTRAL] OK, thank you. And I'm showing that we received the claim. Hold on one moment, let me go back.
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 348.
[AGENT][NEUTRAL] 7509.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim a total of $311.34.
[AGENT][NEUTRAL] Which was um the $311.34 was the balance that they had left for their outpatient expenses, so it was all applied to this.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, is there any patient responsibility?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility because we're not the major medical insurance company.
[CUSTOMER][POSITIVE] OK. Thank you so much for that information. And upon checking on my side and the paid amount of $311.34 was recouped, right?
[AGENT][NEUTRAL] Recouped. What do you mean by recouped as then we took it back?
[CUSTOMER][NEUTRAL] Yeah, upon checking on my side, we have found the amount $311.34 were recouped.
[AGENT][NEUTRAL] Hold on one moment, I don't have any record of that.
[CUSTOMER][NEUTRAL] Did you receive any equipment?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The insured submitted the claim as well, but we denied it because we had paid directly to you all, but let me see if this check has cleared or if there's an update. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah OK.
[AGENT][NEUTRAL] Yeah, I'm not showing any record of a payment being uh recouped or returned to us. Check number 1,866,050 cleared on [PII].
[CUSTOMER][NEUTRAL] Could you please say the check number again?
[AGENT][NEUTRAL] Sure, 1,866,050.
[CUSTOMER][NEUTRAL] OK, thank you it was cleared on August?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much for that information and did.
[CUSTOMER][NEUTRAL] You didn't receive any equipment or you didn't receive any amount, that's correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much for that information.
[CUSTOMER][NEUTRAL] Yeah, thank you. And could you please send a copy of your video fax?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Yeah. The fax number is [PII]. And attention to my name, [PII].
[AGENT][NEUTRAL] And that was [PII]. Attention, [PII].
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][POSITIVE] All right, so I'll go ahead and send the explanation of benefits over to you now, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Could you please spell out your name?
[AGENT][NEUTRAL] Sure, my name is [PII] The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Thank you. Can I get the call reference number?
[AGENT][NEUTRAL] Um, so there's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much for that information and also thank you for assisting today. Have a great day. Thank you.
[AGENT][POSITIVE] Thank you, [PII]. You're welcome. Was there anything else I can help with?
[CUSTOMER][NEUTRAL] I think I had done with the all the claims and then thanks for that information you've given today.
[AGENT][NEUTRAL] Bye bye.
[AGENT][POSITIVE] Thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Thank you, bye bye.