AccountId: 011433970860
ContactId: d7ee8f59-42d1-453b-a35b-39dd1f302858
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 515217 ms
Total Talk Time (AGENT): 151923 ms
Total Talk Time (CUSTOMER): 94658 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/d7ee8f59-42d1-453b-a35b-39dd1f302858_20250318T21:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] I'm calling from the provider's office, checking on the claim.
[AGENT][NEUTRAL] OK, I can help you with the claim status. Can I please get your callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII] direct number?
[AGENT][NEUTRAL] Thank you. And then what is the name of the uh provider's office you're calling from?
[CUSTOMER][NEUTRAL] his name is HC Florida Mercy Hospital.
[AGENT][NEUTRAL] Thank you. And can you please give me the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes, and the policy number is 02519291. And this name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, let me pull that policy up real quick.
[AGENT][NEUTRAL] OK, and then what is the date of service of the claim and the charge amount?
[CUSTOMER][NEUTRAL] Service date is [PII]. Charge amount of $103,407.39.
[AGENT][NEUTRAL] OK, and then what's the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] One moment, please fill in that information. Thank you.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEUTRAL] So checking on that. Give me one moment here.
[AGENT][POSITIVE] Sure. Take your time.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] That is $2,916 even.
[AGENT][POSITIVE] OK, thank you so much. I'm going to put you on a brief hold, Miss [PII], while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] F
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me. I have the claim number. The claim number is 3552093.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And the claim was denied needing the explanation of benefits from the primary insurance carrier.
[CUSTOMER][POSITIVE] OK, thank you so much for that information.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] One moment, checking on that. So, uh, when we did submitted that information to you.
[AGENT][NEUTRAL] OK, um, can you give me the date that you submitted it?
[CUSTOMER][NEUTRAL] Yes, it was submitted on [PII].
[AGENT][NEUTRAL] Mm let me see.
[AGENT][NEUTRAL] I do find that it was submitted, um, it changed the claim number, let's see, uh, to 3567055.
[AGENT][NEUTRAL] And we received it on [PII].
[AGENT][NEUTRAL] Uh, and
[AGENT][NEUTRAL] The remarks say insured's primary insurance provided full benefits. There are no benefits payable.
[CUSTOMER][NEUTRAL] OK. Is it like the primary paid more than your allowed amount?
[AGENT][NEUTRAL] Uh, all I can see is just the remarks, and the remarks are the insured's primary insurance provided full benefits. There are no benefits payable.
[CUSTOMER][NEUTRAL] May I know what does that mean?
[AGENT][NEUTRAL] That means the insured, the primary insurance paid.
[AGENT][NEUTRAL] Full benefits. So there are no benefits payable.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, thank you so much for that information.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And that is all on this one. Could you please provide me with the allowed amount uh for the secondary on this claim?
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] OK, and this is just to provide benefits. It's not a guarantee of payment. Uh, so the insured has, uh,
[AGENT][NEUTRAL] Outpatient inpatient benefits of let's see.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Of $1000 per occurrence and then also has outpatient benefits of $500 per occurrence.
[CUSTOMER][POSITIVE] OK. Thank you so much for that. And that is all for this one. Could you please provide me with the reference number?
[AGENT][NEUTRAL] Yes ma'am, you can use my name [PII] and date.
[CUSTOMER][POSITIVE] Thank you for assisting. Have a great day. Thank you.
[AGENT][POSITIVE] You have a wonderful day too. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] Yeah, no, that is all. Thank you.
[AGENT][POSITIVE] Thank you. You have a great night and thanks for calling APL.
[AGENT][NEUTRAL] Bye-bye.