AccountId: 011433970860
ContactId: a661ccf6-a3bc-4521-b4d4-9b6946ad780c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 467019 ms
Total Talk Time (AGENT): 166406 ms
Total Talk Time (CUSTOMER): 189010 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/a661ccf6-a3bc-4521-b4d4-9b6946ad780c_20250423T13:28_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, [PII]. This is [PII] calling from provider's office uh to check the status of the claim.
[AGENT][POSITIVE] OK, well, 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] yeah
[CUSTOMER][NEUTRAL] Yeah, I have to check for that. Uh, can you please wait for one minute?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah, actually I'm having only one account, that's it. I just said.
[AGENT][NEUTRAL] OK. And may I have, may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, sure. And the best callback number, it is [PII].
[CUSTOMER][NEUTRAL] Can you please uh spell your name?
[AGENT][NEUTRAL] Yes, my name is [PII].
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][NEUTRAL] You're welcome. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, it is 02335900. M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Patient's last name, it is [PII]. First name [PII]. 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 bills for the claim?
[CUSTOMER][NEUTRAL] Yeah, sure. Date of service for this claim it is [PII]. And the total bill amount for this claim, it is $8,404 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, sure. It is HCA Florida Palms West Hospital.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And did you need the original claim status or the resubmitted claim?
[CUSTOMER][NEUTRAL] Original claim status.
[AGENT][NEUTRAL] The claim was received on [PII].
[CUSTOMER][NEUTRAL] Just one minute. I will be documenting for 2. OK.
[AGENT][NEUTRAL] The claim number is 3
[CUSTOMER][NEUTRAL] When it was processed.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] When it was processed.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] OK. Claim number?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] The claim number is 3569633.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] And it was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] The need for, uh, primary explanation of benefits. Actually, previous user has sent it, uh, can you please check, uh, have you received that or not?
[AGENT][NEUTRAL] Yes, that's why I asked, did you want the original or the correct the claim? So you wanted the second one?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so we received that claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On the same day?
[AGENT][NEUTRAL] No, it was received on [PII], hold on, I'm gonna give you all the information. It was received on [PII].
[CUSTOMER][NEUTRAL] When it was processed.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 1900.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we pay to the claim $500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $500 even, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] What is the allowed amount?
[AGENT][NEUTRAL] $500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is the patient's responsibility?
[AGENT][NEUTRAL] We don't determine patient responsibility because we're not the major medical insurance company.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] No patience system. Uh, when the claim was paid, when it was paid, date, date?
[AGENT][NEUTRAL] Again, [PII].
[CUSTOMER][NEUTRAL] OK. Uh, the mode of payment?
[AGENT][NEUTRAL] It was a single check. Did you need the check information?
[CUSTOMER][NEUTRAL] I need only check number.
[AGENT][NEUTRAL] Only check number, OK, 204-0188.
[CUSTOMER][NEUTRAL] Mm mm. OK. And uh when and the uh the check was issued on same [PII], right?
[AGENT][NEUTRAL] [PII], correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] should
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It is cashed or not cashed?
[CUSTOMER][NEUTRAL] the code to the.
[AGENT][NEUTRAL] Um, hold on one moment. That's the check information. Let me get it for you.
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Um, no, the check is still outstanding. It was just sent out two days ago.
[CUSTOMER][NEUTRAL] OK. So not cash, right?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Correct, it's still, yes, the check is not cash.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, single amount or bulk amount?
[AGENT][NEUTRAL] It was a single check?
[CUSTOMER][NEUTRAL] Single. What is that amount? Can you please tell me?
[AGENT][NEUTRAL] $500.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] Can you please uh provide me the pay to address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And can you please fax us the the PDOB?
[AGENT][NEUTRAL] Yes, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][NEUTRAL] And um, whose attention should I put it to?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][POSITIVE] Yes, you are correct.
[AGENT][POSITIVE] All right, so I'm sending the explanation of benefits over to you now. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Yeah, that's all the information I need from you.
[AGENT][POSITIVE] Alright, well, thanks for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Bye. Thank you.
[AGENT][POSITIVE] Thank you, bye bye.