AccountId: 011433970860
ContactId: bdc89115-50a9-4c58-93df-0ba9d6bd8ba7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 399309 ms
Total Talk Time (AGENT): 109796 ms
Total Talk Time (CUSTOMER): 116475 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/bdc89115-50a9-4c58-93df-0ba9d6bd8ba7_20250521T19:49_UTC.wav
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[AGENT][NEUTRAL] This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, I'm [PII] Last name initially it's calling from the provider's office to check up on the claims denial.
[AGENT][NEUTRAL] OK [PII], I can help you with the claim. Can I please get your callback number, sir, just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] And patient's policy number is 02565852.
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[CUSTOMER][POSITIVE] OK, no issue.
[AGENT][NEUTRAL] And what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] The service is 124 of 2024 for the charge amount of $137,213.66.
[AGENT][NEUTRAL] Thank you. And then what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] $350.
[AGENT][NEUTRAL] OK. And what is the name of the facility you're calling from, [PII]?
[CUSTOMER][NEUTRAL] That's here, Florida Kendal Hospital.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a quick hold [PII] while I look up this claim information and I'll be right back with you, sir.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII], you mentioned that the claim was previously denied. Do you have the claim number for the denied claim?
[CUSTOMER][NEUTRAL] Yeah. Yes, it's 356.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll just repeat it. It's 356-933.
[CUSTOMER][NEUTRAL] 9
[AGENT][NEUTRAL] OK, yeah, I'm showing that this claim was a duplicated claim. Let me see what the remarks say.
[CUSTOMER][NEUTRAL] What was the original one?
[AGENT][NEUTRAL] That's what I'm looking for.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so this is the remark on the claim.
[CUSTOMER][NEUTRAL] Go.
[AGENT][NEUTRAL] The above reference claim appears to be a duplicate of a previously submitted expense benefit has been made payable to the insured, so the insured was paid for this claim.
[CUSTOMER][NEUTRAL] you wanna.
[CUSTOMER][NEUTRAL] OK. And what, uh, like the, in the original one, there is a denial or speed.
[AGENT][NEUTRAL] Uh, I can't give any information other than the insured.
[AGENT][NEUTRAL] Was paid
[CUSTOMER][NEUTRAL] So we have to contact the insured or do you have any payment details or some information?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I have no information other than that the insurance was paid.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. So we have to contact uh to the insurer.
[AGENT][NEUTRAL] That is um
[AGENT][NEUTRAL] Up to the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do you have any number for them?
[AGENT][NEUTRAL] No, sir, I can't give out that information.
[CUSTOMER][NEUTRAL] So you don't have any information?
[AGENT][NEUTRAL] No sir, the insured was paid on the claim.
[CUSTOMER][NEUTRAL] Like the insured party has paid the claim, right?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The insured was paid for the claim, the.
[AGENT][NEUTRAL] That's the only information I have.
[CUSTOMER][NEUTRAL] The patient.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Like the patient was paid for this place?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] primary that you need.
[CUSTOMER][NEUTRAL] So like uh.
[CUSTOMER][NEUTRAL] You don't have any information about what amount is paid and when was the amount paid?
[AGENT][NEUTRAL] No, sir, I can't give out that information.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So whom we have to reach out to?
[AGENT][NEUTRAL] That's dependent on the provider what they decide to do.
[CUSTOMER][NEUTRAL] And what is the reference number?
[AGENT][NEUTRAL] Yes sir, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you for your assistance. Bye.
[AGENT][POSITIVE] You're welcome, sir. You have a wonderful day and thank you for calling APL. Bye-bye, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Bye.