AccountId: 011433970860
ContactId: ca13658c-e32f-4072-809a-57301207dc32
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 869679 ms
Total Talk Time (AGENT): 186067 ms
Total Talk Time (CUSTOMER): 174690 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/ca13658c-e32f-4072-809a-57301207dc32_20250203T19:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, this is [PII]. I'm calling from provider's office checking on a claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh, can you repeat that again, please? [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you and what is the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. And what's the patient's date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And patients policy number?
[CUSTOMER][NEUTRAL] Uh, patient's policy number is.
[CUSTOMER][NEUTRAL] 1,335,660
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, 8.
[AGENT][NEUTRAL] OK, let me pull that policy up real quick.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK, and what is the date of service?
[CUSTOMER][NEUTRAL] Uh, date of service is [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] $37,588 even.
[AGENT][NEUTRAL] Thank you. And what's the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] $972.17.
[AGENT][NEUTRAL] Thank you and then what's the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] HCA Florida Mercy Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, [PII], while I look up this claim for you and I'll be right back.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you for holding for me, [PII]. I did find the claim.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The claim number is 34873778.
[AGENT][NEUTRAL] And the claim was denied because we need the EOB from the primary insurance.
[CUSTOMER][NEUTRAL] Can I have the received it and the processed date, please?
[AGENT][NEUTRAL] Yes, ma'am. Let me look that up.
[AGENT][NEUTRAL] We received the claim on [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And uh can I have your fax number to send the primary you be?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And is there any timely filing for sending primary away?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, actually, I have 2 more claims. Can you help me with that as well, please?
[AGENT][NEUTRAL] Is it for the same patient?
[CUSTOMER][NEUTRAL] Different patient.
[AGENT][NEUTRAL] OK. What's the next patient's name?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, before that, may I know the call reference please for this patient?
[AGENT][NEUTRAL] Yes, you can use my name [PII].
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] OK. Just a second, please.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. So next,
[CUSTOMER][NEUTRAL] Member ID number is
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, and then what's the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And what is the patient's date of birth?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] And the date of service is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And charge mount?
[CUSTOMER][NEUTRAL] $6,556 even.
[AGENT][NEUTRAL] OK, and charges after primary paid their part?
[CUSTOMER][NEUTRAL] $500 even.
[AGENT][NEUTRAL] OK, and is it for the same facility?
[CUSTOMER][NEUTRAL] No, it's it's a [PII] Northwest Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold again. I'll be right back. I'm gonna look this claim up for you.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you again.
[AGENT][NEUTRAL] So for this insured, the claim number is 3504539.
[CUSTOMER][POSITIVE] Yes, thank you.
[AGENT][NEUTRAL] The claim was received on [PII] and processed on [PII].
[AGENT][NEGATIVE] And it was denied for the same reason, we need the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Same fax number, right?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] You can fax it, yes, OK, just a moment.
[CUSTOMER][NEUTRAL] for
[CUSTOMER][NEUTRAL] So, the next member ID.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 02521741
[AGENT][NEUTRAL] OK, and what is the member's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK. And
[AGENT][NEUTRAL] Let me look him up real quick.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] on the
[AGENT][NEUTRAL] Alright, and what's the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and then what is the charge amount?
[CUSTOMER][NEUTRAL] $8,674 even.
[AGENT][NEUTRAL] And the charges after primary?
[CUSTOMER][NEUTRAL] $692.87.
[AGENT][NEUTRAL] OK, and is it for the same facility?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] No, it's for uh Grand Strand Medical Center.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, I'm gonna put you on hold. I'm gonna look this one up and I'll be right back.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I'm, hi [PII], I've got the next one for you. Uh, the claim number is 351-7080. We received the claim on [PII] and processed it on [PII] and the claim was denied for the same reason that we need the EOB from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] That's one.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Thank you so much. That's all for now.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You're welcome. You have a good week, [PII]. Thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.