AccountId: 011433970860
ContactId: a88aeec4-2c5d-481e-a6d5-9149480fbd47
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 852460 ms
Total Talk Time (AGENT): 215190 ms
Total Talk Time (CUSTOMER): 192914 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/a88aeec4-2c5d-481e-a6d5-9149480fbd47_20250409T17:08_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APR. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from University of Miami to check on your claim status. Could you please help?
[AGENT][NEUTRAL] Uh yes [PII], I can help you with the claim status. Can I please get your callback number, sir, just in case our call.
[CUSTOMER][NEUTRAL] Sure. It will be [PII] with the extension of [PII].
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] The patient's first name will be [PII], the last name will be [PII]. Patient's date of birth is [PII].
[AGENT][NEUTRAL] And the patient's, um, policy number, please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It will be 01569897 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, let me pull in. Yes, it's T O R Y.
[CUSTOMER][NEUTRAL] Can you spell your name?
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK and then um can you give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Sure. And the date of service will be, it is [PII]. The total bill amount is $299 even.
[AGENT][NEUTRAL] OK, and that data.
[AGENT][NEUTRAL] The [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] So they have been left a copy of $100?
[AGENT][NEUTRAL] OK. All right, I'm gonna put you on a quick hold, Mr. [PII], while I look up this claim for us and I'll be right back.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 65
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you, [PII], for holding for me. I have the claim ready for you. The claim number is 356-658-5.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So, can I get the UB copy of this one?
[AGENT][NEUTRAL] Yes sir, may I have your fax number and I'll fax it over to you.
[CUSTOMER][NEUTRAL] It will be [PII].
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] OK, and that's [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I get that fax ready for you, [PII], and I'll be right back sir.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] You
[AGENT][POSITIVE] Thank you so much for holding for me, [PII]. I have that fax on its way to you now.
[CUSTOMER][NEUTRAL] My
[CUSTOMER][NEUTRAL] OK. The, the claim has been denied for offices it does not cover under the patient plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So it is on the member responsibility, right? We can build the business, right?
[AGENT][NEUTRAL] We don't give patient responsibility. We let the, the provider determine that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So this provider?
[AGENT][NEGATIVE] Right. We do not give patient responsibility.
[CUSTOMER][NEUTRAL] So it is provided determined then, right?
[AGENT][NEUTRAL] Right, the provider has to make that decision.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and can I get the claim receipt date and the process date?
[AGENT][NEUTRAL] Yes sir, let me look that up real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, we received the claim on [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] The dinner will be same or different, the process it.
[AGENT][NEUTRAL] The process date was [PII].
[CUSTOMER][NEUTRAL] And the dinner date?
[AGENT][NEUTRAL] Also the same day.
[CUSTOMER][NEUTRAL] OK, and I do have another member ID. Can I go ahead with the next one?
[AGENT][NEUTRAL] Yes, sir. Can you give me their name?
[AGENT][NEUTRAL] Date of birth and policy number.
[CUSTOMER][NEUTRAL] Sure, is there, is there any color for this claim?
[AGENT][NEUTRAL] Yes, all of them will be my name, [PII] and today's date.
[CUSTOMER][NEUTRAL] OK. And the next member ID number will be, it is 00, sorry, it will be 01419065.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And what is their name and date of birth?
[CUSTOMER][NEUTRAL] The patient's first name will be [PII], the last name will be [PII]. Patient's date of birth is [PII].
[AGENT][NEUTRAL] OK, let me pull this one in for us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK and then what is uh [PII]'s data service and charge amount?
[CUSTOMER][NEUTRAL] The claim date of service will be, it is [PII]. The total bill amount is $298 even.
[AGENT][NEUTRAL] And then the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] P
[CUSTOMER][NEUTRAL] So you're asking the the total charge amount of the and they are left amount right?
[AGENT][NEUTRAL] The um the amount after the primary paid their part.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, one moment.
[AGENT][POSITIVE] Yes, sir. Take your time.
[CUSTOMER][NEUTRAL] It will be $65 even.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and is it for the same facility?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. All right. A quick hold again while I look up this claim, I will be right back.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you [PII] for holding for me. I have this claim ready.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 356-6204.
[AGENT][NEUTRAL] The claim was denied because the services were rendered after the policy termination date.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] And the policy terminated on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there are no active policies at this time.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The policy has been termed on [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And can I get the patient policy affected date?
[AGENT][POSITIVE] I'm sorry
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The policy affecting that.
[AGENT][NEUTRAL] The policy effective date was
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Can I get the claim receipt date and the process date? So, the claim re date and dinner date.
[AGENT][NEUTRAL] Yes, sir. Let me look.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Let me look that up.
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] And process the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] The claim number will be 356-6204, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, thanks so much, [PII] for the information and have a nice day.
[AGENT][POSITIVE] You have a great day too. Is there anything else I can help you with, [PII], before we go?
[CUSTOMER][NEUTRAL] Yeah, that's it for now.
[AGENT][POSITIVE] OK, have a beautiful day and thanks for calling APL.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Bye-bye.