AccountId: 011433970860
ContactId: c977e3b3-9bde-42bc-af94-a366dd43794c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1782650 ms
Total Talk Time (AGENT): 384858 ms
Total Talk Time (CUSTOMER): 453366 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/c977e3b3-9bde-42bc-af94-a366dd43794c_20250421T17:58_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon and thank you for calling APL. This is So. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, sir. This is [PII] calling from provider's office to check on a claim 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].
[AGENT][NEUTRAL] OK, and may I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Uh, yes, facility name is the CA Florida West Side Hospital.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] It's 01887176 M as in Mike, L as in Lime number 8.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh yes. The member name is it's
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Last name is [PII]. It's [PII].
[AGENT][NEUTRAL] OK. And what's her date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, yeah, that's right. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] D of service is [PII], it's [PII].
[CUSTOMER][NEUTRAL] And the total charge amount for this one is
[CUSTOMER][NEUTRAL] It's $31,856 and even.
[AGENT][NEUTRAL] OK. And so that is [PII], the amount of $31,856. Is that correct?
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] OK, let me see if I can find this claim and for future, you can check claim status online through our website at [PII], and that's just optional and bear with me. OK, looks like we're waiting for the explanation of benefits from the primary insurance. We have not received that document as of today.
[CUSTOMER][NEUTRAL] OK. I did not receive it, right? One moment. And can you tell me how can we send this? Do you have any fax number?
[AGENT][NEUTRAL] Right. Mhm.
[AGENT][NEUTRAL] Yes, you can fax it or mail it. The fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]. Thank you. One moment.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And what will be the received date of this claim?
[AGENT][NEUTRAL] It was received on [PII] process [PII].
[CUSTOMER][NEUTRAL] [PII] and processed on [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] [PII]. Thank you.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] And I just want to confirm I do have the claim number as uh.
[CUSTOMER][NEUTRAL] 3552255, is that the correct one?
[AGENT][POSITIVE] That is correct, Mr. [PII].
[CUSTOMER][POSITIVE] Thank you. And is there any time if I need to send this?
[AGENT][NEUTRAL] No, we don't have timely filing limits for you to submit a primary EOB.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I just want to know if you can help me with some more claims.
[AGENT][NEUTRAL] OK. How many more do you have?
[CUSTOMER][NEUTRAL] Uh, I do see more 3 claims.
[AGENT][NEUTRAL] OK, sure. Um, bear with me just a second. Let me finalize the note on this one, OK? I'll have to make a note on each one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Give me just a second, OK, one moment, I'm gonna put you on a brief hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, go ahead with the next policy number, Mr. [PII].
[CUSTOMER][NEUTRAL] Oh yeah, it's going to be 02511179. M as in Mike, L as in Lion, number 7.
[AGENT][NEUTRAL] OK. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] And the patient name is [PII]. It's [PII] Date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, perfect. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The date of service of this claim is [PII] and the total charge amount of 43,000.
[CUSTOMER][NEUTRAL] $846.73.
[AGENT][NEUTRAL] OK, so that's [PII] $43,846.73.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] So it's 43,800.
[CUSTOMER][POSITIVE] $46.73. That's correct.
[AGENT][NEUTRAL] Mhm. Yeah. OK.
[AGENT][NEUTRAL] Let me see if I have anything else. Bear with me.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, we have not received that claim as of today.
[CUSTOMER][NEUTRAL] One moment. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me check.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Once again,
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] OK, so there is no claim on file, right? I can check it with the, the, uh.
[CUSTOMER][NEUTRAL] A bulk amount which is $43,891.42.
[AGENT][NEUTRAL] Oh, it's not the amount it's the date of service there's nothing for that month.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, mhm. And the date of service. Thank you. It's uh [PII]. OK. And uh we have sent the claim uh via mailing address to the
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] To the mailing address which is
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. Is that correct?
[AGENT][NEGATIVE] That's an incorrect address.
[CUSTOMER][POSITIVE] OK. Thank you for that information.
[AGENT][NEUTRAL] OK, do you need the correct address?
[CUSTOMER][POSITIVE] That's good. I just, what's that?
[AGENT][NEUTRAL] Do you need the correct address? That was an incorrect address.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, what's the correct address?
[AGENT][NEUTRAL] The correct address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] City, [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] And do you have the payer ID?
[AGENT][NEUTRAL] OK, then this one needs to be either fax or mail. I can give you the fax number.
[CUSTOMER][NEUTRAL] OK, fax number?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, so let me see if I need any other information.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. And uh can you please provide me the effective date, contamination date of this policy?
[AGENT][NEUTRAL] Mm. Mhm. Yes. All right. We have an effective date of [PII]. It is active at the moment.
[CUSTOMER][NEUTRAL] And term date, is it still active?
[AGENT][NEUTRAL] Yes, still active.
[CUSTOMER][NEUTRAL] Thank you. And, and do you have any group number?
[AGENT][NEUTRAL] Um, yes, let me get that for you, one moment.
[AGENT][NEUTRAL] The group number is 21649.
[CUSTOMER][NEUTRAL] 649. And what's the group name?
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] OK, let me get that for you.
[CUSTOMER][NEUTRAL] And also what kind of plan does have? Is it HMO PPOPS kind of?
[AGENT][NEUTRAL] This is not a major medical, so it's not PPO HMO or anything like that. It's just a commercial.
[AGENT][NEUTRAL] Um, the name of the group is Dylan Construction Co.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Deal and construction.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Thank you for providing this information.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And commercial.
[CUSTOMER][NEUTRAL] And is there any timely filing to build this?
[AGENT][NEUTRAL] There's no timely filing limits to submit a claim.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] One moment moving on to the next claim.
[AGENT][NEUTRAL] You say you don't need any other information on this one, so I can finalize my notes.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] Yes, so the next one, the member ID is
[CUSTOMER][NEUTRAL] It's going to be
[CUSTOMER][NEUTRAL] 02465027
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient name is
[CUSTOMER][NEUTRAL] Day, it's [PII]. Date of uh date of birth is [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes, so the on the date of service is going to be.
[CUSTOMER][NEUTRAL] So sorry, it's [PII] total charge amount is going to be 62,000.
[CUSTOMER][NEUTRAL] $302 even.
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][NEUTRAL] No, it's [PII].
[AGENT][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me see if I can find this [PII] moment.
[CUSTOMER][NEUTRAL] In
[AGENT][NEUTRAL] OK. All right. Looks like we're waiting on the primary explanation of benefits for this one.
[CUSTOMER][NEGATIVE] OK. I want to receive and denied it.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Bear with me.
[AGENT][NEUTRAL] OK, it was received on [PII], processed [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. Thank you. And you still did not receive the EOB, right?
[AGENT][NEUTRAL] Correct. As of today, we have none.
[CUSTOMER][NEUTRAL] OK. And I just want to confirm the fax number is going to be the same, right? It's [PII]?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, thank you. And I do have a claim number as 254.
[CUSTOMER][NEUTRAL] 2349. Is that correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you. Moving on to the next one, no.
[AGENT][NEUTRAL] Um, bear with me, let me make a note.
[AGENT][NEUTRAL] OK, what's the next policy?
[CUSTOMER][NEUTRAL] The policy number for the next one is going to be?
[CUSTOMER][NEUTRAL] It's 02518815.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It's, it's [PII], sorry, it's [PII]
[CUSTOMER][NEUTRAL] He assuming, last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the time?
[CUSTOMER][NEUTRAL] The service is [PII].
[CUSTOMER][NEUTRAL] And the total charge for this one is $18,246 and even.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that was [PII], correct?
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] OK, so we also need the primary EOB.
[CUSTOMER][POSITIVE] OK. Thank you for the information.
[AGENT][NEUTRAL] On this one.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] This was received on [PII], processed [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Process [PII]. Thank you.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] The information and also,
[CUSTOMER][NEGATIVE] That shit.
[CUSTOMER][NEUTRAL] Can you please uh tell me the claim number as well?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] we
[AGENT][NEUTRAL] And the claim number is.
[AGENT][NEUTRAL] 356-68778.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 6 it's 356.
[AGENT][NEUTRAL] 6878.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 687 8.
[CUSTOMER][NEUTRAL] 68. All right, thank you. And the fax number and the time the filing will be same, right?
[AGENT][NEUTRAL] The same.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] M.
[CUSTOMER][NEUTRAL] Moving on to the next game.
[AGENT][NEUTRAL] Bear with me.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Are you
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yes, the next number ID is 02478746 M as [PII].
[AGENT][NEUTRAL] What's the name and date of birth?
[CUSTOMER][NEUTRAL] Member name is?
[CUSTOMER][NEUTRAL] [PII] last name is [PII].
[CUSTOMER][NEUTRAL] He, it's [PII] Yeah, it's [PII] here. Date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes, the new services.
[CUSTOMER][NEUTRAL] [PII] total charges $25,432 and yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, that's [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, bear with me, we have processed this one twice.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm still waiting on the hobby.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so it was processed the first time the original claim was processed and paid 300, which is the maximum payable benefit for the date of service.
[AGENT][NEGATIVE] And we received the claim again and it was denied indicating that the maximum benefit for the date of service has been exhausted.
[CUSTOMER][NEUTRAL] OK, so it's duplicate, right?
[AGENT][NEUTRAL] Basically, it is, because we already sent the 300, which is the maximum.
[CUSTOMER][NEUTRAL] OK. And also received date of this claim?
[AGENT][NEUTRAL] For the original one or the most recent one?
[CUSTOMER][NEUTRAL] The original one.
[AGENT][NEUTRAL] The original, OK, bear with me just a second.
[AGENT][NEUTRAL] OK, it was received on [PII] process [PII].
[CUSTOMER][NEUTRAL] Cho
[CUSTOMER][NEUTRAL] And is it what's an order amount?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 300.
[CUSTOMER][NEUTRAL] No patient responsibility, right?
[AGENT][NEUTRAL] We only paid 300.
[CUSTOMER][NEUTRAL] Can I get the check number or EFT number?
[AGENT][NEUTRAL] It is a check. It's a single check, a paper check.
[AGENT][NEUTRAL] The check number is 1,858,090.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][POSITIVE] Thank you. Is it a bulk amount?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] The single check and paper check.
[CUSTOMER][NEUTRAL] A single check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] What's the issue date?
[AGENT][NEUTRAL] [PII], which is the process date.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And claim number?
[AGENT][NEUTRAL] That is 346-9968.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And also if uh can you please send us the original UB fax.
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. [PII].
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] To what attention?
[CUSTOMER][NEUTRAL] Uh, attention to the patient. sorry, attention to my name, it's [PII]. Sorry, it's [PII].
[AGENT][NEUTRAL] To your name?
[AGENT][NEUTRAL] [PII], any initial?
[CUSTOMER][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Yeah, it's [PII], OK.
[AGENT][NEUTRAL] OK. Um, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] OK. And I just want to know if you can help me with. I do have more claims. If you can help me with that as well.
[AGENT][NEUTRAL] Yeah, when I come back, OK, let me just go ahead and send this one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.