AccountId: 011433970860
ContactId: aa2758f4-71e8-4b9a-98ed-9c4146a86882
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1564949 ms
Total Talk Time (AGENT): 310575 ms
Total Talk Time (CUSTOMER): 358468 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/aa2758f4-71e8-4b9a-98ed-9c4146a86882_20250421T14:31_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, sir. How are you? My name is [PII]. I'm calling from the provider's office to know the claim status. Would you like to help me out?
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. Our callback number is [PII].
[AGENT][NEUTRAL] OK, and you're calling from which facility for annotation? What's the name?
[CUSTOMER][NEUTRAL] Uh, the facility's name is HCA Florida Mercy Hospital.
[AGENT][NEUTRAL] Mercy Hospital.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Uh patient's policy number is 025.
[CUSTOMER][NEUTRAL] 11179 M as in Mary, L as in Lima, 7.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, sure. The name is uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, the date of service is [PII] and the bill amount is $152013 and that's, that's it. $152013 even.
[AGENT][NEUTRAL] $152,0013?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] OK, the amount that you're giving me, is it 152,000?
[AGENT][NEUTRAL] At $13.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Yes, yes, exactly.
[AGENT][NEUTRAL] OK. Alright, one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, and for future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it looks like we're needing the explanation of benefits from the primary insurance to continue the processing of this claim.
[AGENT][NEUTRAL] As of today, we have not received that email.
[CUSTOMER][NEUTRAL] We already sent.
[CUSTOMER][NEUTRAL] Uh, you have not received it till now?
[AGENT][NEGATIVE] No, we have not received AOB.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, no problem. Just give me a moment. Uh, the fax number is [PII], right?
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Yeah, one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is there any timely filing limit to submit this uh uh primary OB?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, right? OK.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Uh, we can send to the same fax number, right? [PII], right?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Yes, yes, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Yeah, I have some more accounts. So, would you please help me with that information also?
[AGENT][NEUTRAL] Oh sure, I just need to make a note on this one. Do you need any other information on this one?
[CUSTOMER][NEUTRAL] Uh, nothing.
[AGENT][NEUTRAL] OK, let me make a note.
[CUSTOMER][NEUTRAL] Uh, can I get the
[CUSTOMER][NEUTRAL] Yeah, sure. And can I get the call reference number also?
[AGENT][NEUTRAL] We don't have reference numbers, you can use my name into the estate.
[CUSTOMER][NEUTRAL] OK. Can you spell your name if you don't mind?
[AGENT][NEUTRAL] My name is [PII]. That's [PII], last [PII] [PII].
[CUSTOMER][NEUTRAL] Sorry, uh [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Last initial [PII].
[CUSTOMER][POSITIVE] The less than day. Thanks.
[CUSTOMER][POSITIVE] [PII], thank you.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Maybe one more minute.
[CUSTOMER][POSITIVE] No problem. Take your own time.
[AGENT][NEUTRAL] What's the next policy number?
[CUSTOMER][NEUTRAL] One second, just give me a moment.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's a
[CUSTOMER][NEUTRAL] The policy number is
[CUSTOMER][NEUTRAL] 022
[CUSTOMER][NEUTRAL] 70574.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, it's uh [PII] and the date of birth is [PII].
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, and what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the bill amount is $2,221 even.
[AGENT][NEUTRAL] Well, it's $2,231.
[CUSTOMER][NEUTRAL] $21.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] OK, we received the claim on [PII], processed [PII], and the claim was denied. The reason for this denial is that the service was rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] Uh, it is denied because, uh, the coverage is the terminator, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Can I get the term date and uh
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Policy date?
[AGENT][NEUTRAL] The effective date of the policy was [PII] and it terminated [PII].
[CUSTOMER][NEUTRAL] Uh, [PII], right?
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just give me a moment. Let, let me pull another account.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The policy number is 010.
[CUSTOMER][NEUTRAL] 70427.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, I don't think I got that one right. Let me have that number one more time.
[CUSTOMER][NEUTRAL] No problem. It's 01070427.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The patient's name is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, and what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Data service is [PII] and the bill amount is $46,688 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Bear with me. Let's pull that you'll be on this one.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, we received this claim on [PII], processed [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the claim was denied, the denial reason is that the maximum amount payable for this occurrence has been met.
[CUSTOMER][NEUTRAL] OK. 1 2nd.
[AGENT][NEUTRAL] So it's benefit [PII]
[CUSTOMER][NEUTRAL] Uh, is it the total responsibility belongs to the provider or the patient?
[AGENT][NEUTRAL] It's up, it's up to the provider's discretion.
[AGENT][NEUTRAL] We don't have any contractual vomit on the remaining. Mhm.
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, no problem. Just give me a moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, the policy number is 2455568.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the date of service and the amount of the time?
[CUSTOMER][NEUTRAL] Date of service is [PII] and the bill amount is $7,861 even.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, bear with me.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I have to wait on the UOB to pull up on this one.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] OK, so this one has a long denial also and let me go ahead and give it to you. I don't know if you want to write it down because it is a long denial.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK. Um, so this one was processed on [PII] and it was denied indicating that we're unable to assign benefits to the provider of records due to a discrepancy with the provider's tax ID number.
[AGENT][NEUTRAL] A letter has been sent to the provider of service.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like any payment benefits were sent to the insured.
[CUSTOMER][NEUTRAL] Uh, you are saying that this is a denial to resume accepting the assignment of benefits from, for the claims filed by your office. We need the com combination of name and
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Mm
[AGENT][NEGATIVE] No, no, no, no, no, that's not what I said. Now can you write down what I said because it's nothing what you're repeating at all.
[CUSTOMER][NEUTRAL] Yeah. Name and tax ID taxpayer identification number, error corrected.
[AGENT][NEGATIVE] The provider's tax ID number, it has a discrepancy.
[CUSTOMER][NEUTRAL] OK. Yeah, that's, that's the one that's showing on this also later.
[AGENT][NEUTRAL] Mhm. When we
[AGENT][NEUTRAL] OK, and when we process the claim, so any benefit will pay directly to the insured.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] OK, no problem. Uh, if we collect the tax ID, tax ID number, would you please accept it?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] We can go ahead and make any corrections once we receive that W-9 and information about any changes to the provider of service. Now, at this point again, the denial reason indicates that any payable benefits for this charge has been sent to the insured, so they cannot be reprocessed and pay again.
[CUSTOMER][POSITIVE] OK. OK. OK. No problem.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Problem. Just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I got that. Uh, let me pull on another account. Just give me a moment.
[AGENT][NEUTRAL] OK, let me make a note on this.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, I'm done with the note.
[CUSTOMER][NEUTRAL] No problem. And uh the, and the accounts policy number is 02462236 M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] What's the name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The uh the date of service is [PII] and the bill amount is $14,740 even.
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] 7887101.
[AGENT][NEUTRAL] OK, looks like we're needing the primary explanation of benefits to continue the processing of this claim. As of today, we have not received that EOB.
[CUSTOMER][NEUTRAL] OK. Would you please check once again, we have sent the primary EOB on, just give me a moment.
[AGENT][NEUTRAL] Yeah, I check any history for that date of service and I don't see any other claims coming in for that date of service in that amount.
[CUSTOMER][NEUTRAL] OK, no problem. We have sent the primary [PII]. Would you please check on the date if you have received?
[AGENT][NEGATIVE] We have not received anything except today.
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] OK, can I get the fax number again? Would you?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There is no timely filing limit to submit this crime, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you. Uh, thank you all. Thanks for providing with the info.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is there anything else can I help you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] Nothing, thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling EPO. Have a good day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] OK.