AccountId: 011433970860
ContactId: b23abf30-b6ae-4fc6-833a-96919c07b9b8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 842179 ms
Total Talk Time (AGENT): 289520 ms
Total Talk Time (CUSTOMER): 220353 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/b23abf30-b6ae-4fc6-833a-96919c07b9b8_20250509T13:46_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] Hi, this is [PII] calling from provider's office to check on the medical status.
[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, it's [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, can you repeat that one more time? [PII].
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Alright, thank you. May I have the name of the facility you're calling from, Mr. [PII]?
[CUSTOMER][NEUTRAL] It's HCA Florida University Hospital.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, it's 022 03926 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh, my name is [PII]. Date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Oh yes, the date of service is [PII].
[CUSTOMER][NEUTRAL] Bill the amount is $17,356 and even.
[AGENT][NEUTRAL] So [PII]. Let me see if I can find this claim.
[AGENT][NEUTRAL] And for future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me pull the explanation of benefits, one moment.
[CUSTOMER][NEUTRAL] And you said your name is?
[AGENT][NEUTRAL] My name is [PII], that's [PII].
[CUSTOMER][POSITIVE] Thank you. So.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. So it looks like we have uh processed the claim on [PII].
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] And the claim was denied. Um, the reason for this denial.
[AGENT][NEUTRAL] Is that um there is a discrepancy with the tax ID from the provider. So any benefits um that were payable was sent to the member.
[CUSTOMER][NEUTRAL] Oh, sorry, you said the tax ID?
[AGENT][NEUTRAL] There was a discrepancy with the tax ID from the provider.
[CUSTOMER][NEUTRAL] Description see tax ID.
[CUSTOMER][NEUTRAL] OK, and you're saying that uh
[CUSTOMER][NEUTRAL] The patient responsibility, uh sorry, charges is based on responsibility.
[AGENT][NEUTRAL] No, um,
[AGENT][NEUTRAL] The OK, so whenever we are unable to accept the assignment of benefits to the, due to a discrepancy of the tax ID, um, what we do is we process the claim and if it's payable, it will be paid to the member.
[CUSTOMER][NEUTRAL] OK. OK. And so you're saying that uh you have paid uh
[CUSTOMER][NEUTRAL] Payment to the member.
[AGENT][NEUTRAL] Correct, the payment has been sent to the to the member, so you will have to get in contact with the member to get that information.
[CUSTOMER][NEUTRAL] All the payment information, correct? OK.
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And can you provide me the allowed paid amount?
[AGENT][NEUTRAL] We can release that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the AOB have not signed, right?
[AGENT][NEUTRAL] We have um released an explanation of benefits with indicating the discrepancy, yes.
[CUSTOMER][NEUTRAL] OK. Thank you. What's the claim number?
[AGENT][NEUTRAL] The claim number is going to be 3591901.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today, Mister [PII]?
[CUSTOMER][NEUTRAL] No call reference number.
[AGENT][NEUTRAL] And we don't have reference numbers.
[CUSTOMER][NEUTRAL] One moment, let me just check.
[AGENT][NEUTRAL] You can use my name in today.
[CUSTOMER][NEUTRAL] Uh, I do see more two claims if you can.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, if you can help me with that.
[AGENT][NEUTRAL] Different members.
[CUSTOMER][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yes, it's for a different number.
[AGENT][NEUTRAL] OK, bear with me just a second. Let me go ahead and make a note on this one so we can move forward to the next one, OK? One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It's gonna be one more minute.
[AGENT][NEUTRAL] All right. What is the next policy number?
[CUSTOMER][NEUTRAL] Uh, it's going to be 02444783.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Member name is [PII], date of birth is [PII].
[AGENT][POSITIVE] OK, perfect. Thank you.
[AGENT][NEUTRAL] And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Audit of service is going to be?
[CUSTOMER][NEUTRAL] [PII], the total bill amount is $21,487 and even.
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me pull this ELB.
[AGENT][NEUTRAL] OK, still waiting on the.
[AGENT][NEUTRAL] All right, looks like we processed this claim on [PII].
[AGENT][NEUTRAL] And we send a benefit amount of $1,87.82 and with the payment of this check, the policy maximum has been exhausted.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Uh, so there is the payment amount, correct?
[AGENT][NEUTRAL] The payment amount is $1,87.82.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] $37.82.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And is there any patient responsibility?
[AGENT][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Uh, let me see. Looks like the charge amount was $3,219. She only had $1,087.82 remaining on her benefits.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] So that's the reason we send that amount. She already exhausted the benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, after the benefits of the patient.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] All
[CUSTOMER][NEUTRAL] All the pay, uh, sorry.
[CUSTOMER][NEUTRAL] All the loan amount is special responsibility, correct?
[AGENT][NEUTRAL] Any remaining balance is up to the provider's discretion. We don't have any contractual involvement on the remaining of the claim, so it's gonna be up to the provider's discretion, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the allowed amount will be the same, right?
[AGENT][NEUTRAL] You need to go back to the primary EOB. It's determined by the primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you for that information.
[CUSTOMER][NEUTRAL] And uh what's the process date last process date of this claim?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let me go back to it. One moment.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Thank you. [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Thank the information and claim number?
[AGENT][NEUTRAL] OK, the claim number is let see.
[AGENT][NEUTRAL] That is 359.
[AGENT][NEUTRAL] 4373.
[CUSTOMER][NEUTRAL] Thank you. I'll just check if I have any claim to.
[CUSTOMER][NEUTRAL] Yes, going on to the last claim.
[CUSTOMER][NEUTRAL] For this one, the member ID is going to be 02462236 M as in Mike L as in Lima 8.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient name is [PII]. It's [PII] Date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] so this is [PII].
[CUSTOMER][NEUTRAL] [PII] total bill amount is $14,740 and even.
[AGENT][NEUTRAL] OK. That's [PII]. OK. Let me see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, for this one, it looks like we are waiting on the primary EOB to continue the processing of the claim. We received the claim and process on [PII].
[CUSTOMER][NEUTRAL] Uh you that information. [PII], correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And how we need to send this? Do you have any fax number?
[AGENT][NEUTRAL] You can either, you can either fax it or mail it. Yes. The fax number is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And is there any time finding to send this?
[AGENT][NEUTRAL] There's no family finding limits.
[CUSTOMER][NEUTRAL] OK you just want to confirm it's uh the fax number is [PII].
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Claim number?
[AGENT][NEUTRAL] OK, that is 3558928.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 892 8.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] And thank you for providing all of this information.
[CUSTOMER][POSITIVE] And have a nice bye-bye.
[AGENT][NEUTRAL] Is there anything else in US?