AccountId: 011433970860
ContactId: a501cec7-2e36-469f-a80d-79235ffebbd2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1422660 ms
Total Talk Time (AGENT): 232152 ms
Total Talk Time (CUSTOMER): 225048 ms
Interruptions: 8
Overall Sentiment: AGENT=0.8, CUSTOMER=-1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/a501cec7-2e36-469f-a80d-79235ffebbd2_20250318T19:17_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. Can you help me with medical claims?
[AGENT][POSITIVE] Yeah, sure, I can assist you with claims. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] Thank you and you're calling from which facility from my location?
[CUSTOMER][NEUTRAL] I'm calling from AdventHealth Heart of Florida.
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Sure. Uh, policy number is 01950852 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure, member's name is [PII] and the date of birth is [PII].
[CUSTOMER][NEUTRAL] Are you
[AGENT][NEUTRAL] Alright, thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Sure, date of services for [PII] with the bill amount $8,519.75.
[AGENT][NEUTRAL] OK. So that's [PII], the amount of $8,519.75.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me check and see if I can find it. Do you mind holding for me?
[CUSTOMER][NEUTRAL] Sure, take it.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for you, Mr. [PII]. OK, looks like we processed the claim on [PII] and we send the benefit amount of 2500.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, $2500 were allowed and paid on this claim, right?
[AGENT][NEUTRAL] That is the payment amount. We are the secondary policy, with the payment of that check, the maximum has been exhausted.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] There was no payment, right, because of the demand.
[AGENT][NEUTRAL] No, no, no, uh, we send the payment of $2500 to the provider. So we did pay 2500. Now, uh, that was not the full amount, that was partial. The reason that it was partial is because this policy has a maximum benefit of 2500, so it doesn't pay more than 2500.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Got it, got it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK, got it. Uh, could you please provide the payment details?
[AGENT][NEUTRAL] Yes, uh, this was a single check, paper check. Um, let me give you the check number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The check number is 2018356.
[CUSTOMER][NEUTRAL] Got it. And
[CUSTOMER][NEUTRAL] May I know if the check was issued and cashed?
[AGENT][NEUTRAL] Um, I can check and see. One moment, I'll have to research.
[CUSTOMER][POSITIVE] OK. Take your time.
[AGENT][NEUTRAL] No. OK, thank you.
[AGENT][NEUTRAL] Yes, this check cleared on [PII].
[CUSTOMER][NEUTRAL] OK, here.
[CUSTOMER][NEUTRAL] Uh, may I know the paper address to which it was issued?
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Uh, could you please verify your address?
[AGENT][NEUTRAL] Um, yes, it was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, we have not received any payments yet, so that is the reason why I was actually calling, but it seems like the pay to address is correct. So.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, may I know the check was cashed?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, it cleared on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] [PII] is correct.
[CUSTOMER][NEUTRAL] Uh, is there a possibility for a stop check and reissue?
[AGENT][NEUTRAL] No, because it's already cleared. That means they already cashed the check. Aman Health already cashed this check.
[CUSTOMER][NEUTRAL] OK, they already can just check. OK. Could you please provide the claim number and receive it.
[AGENT][NEUTRAL] Mhm, yes, let me get that one moment.
[CUSTOMER][NEUTRAL] I just
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] The claim number is 354-0801. Again, that's 354-0801 and it was received [PII], processed [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What's
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you might want to check your system with that check number and see where they apply that check, but the check number is 2018356.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. 8 2018356. OK, got it. Uh
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We have not received any UB for this, so could you please fax the UOB as well?
[AGENT][NEUTRAL] OK, what is the fax number?
[CUSTOMER][NEUTRAL] Fax number is 9293327511.
[CUSTOMER][NEUTRAL] Um, and, uh, is there a possibility, yeah, I'll repeat it.
[AGENT][NEUTRAL] 929
[AGENT][NEUTRAL] OK. Go ahead.
[AGENT][NEUTRAL] OK. 929. I'm gonna repeat it back just to make sure I got it right. [PII].
[CUSTOMER][NEUTRAL] 92933. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 241
[CUSTOMER][NEUTRAL] Yes, that's it.
[AGENT][POSITIVE] OK. All right. Thank you. Yes, go ahead.
[CUSTOMER][NEUTRAL] 295.
[CUSTOMER][NEUTRAL] OK. And uh is there any possibility for a copy of the check to be faxed as well?
[AGENT][NEUTRAL] We will have to request that. That's not something we have here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so I can send you the EOB now. I can go ahead and fax that now, but I, I don't have a copy of the check to send that out to you. Um, so let me go ahead and send a copy of the EOB, OK? One moment.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 141.
[CUSTOMER][NEUTRAL] 544
[CUSTOMER][NEUTRAL] 40
[AGENT][NEUTRAL] And it's gonna be to your attention, Mr. [PII], or what attention?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Uh, it's going to be to [PII] attention.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. All right. I'll send that over to you. It should be there in a few minutes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes sir
[CUSTOMER][NEUTRAL] Could you please spell out your name?
[AGENT][NEUTRAL] Sure. My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] OK. Uh, but the copy of the check, uh, how can we request it where can we request it?
[AGENT][NEUTRAL] OK, and you need that to be mailed or faxed over?
[CUSTOMER][NEUTRAL] Uh, faxed.
[AGENT][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] To which claims or what's the negative value.
[AGENT][NEUTRAL] OK I'm gonna put you in a um brief hold because I need to send a request over to that department OK? one moment.
[CUSTOMER][POSITIVE] OK. Sure. Take your time.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. OK, Mr. [PII], I went ahead and send that request over. So once we receive it, we'll go ahead and send it to you, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, sir. Thank you. Could you please provide the call reference?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's state if you will.
[CUSTOMER][POSITIVE] Sure, OK, sir. Thank you for helping me out. Have a great day. How about that.
[AGENT][POSITIVE] You as well, and thank you for calling APL. Bye-bye.