AccountId: 011433970860
ContactId: d82830e2-a948-45d8-b879-be5d885dedd0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 592520 ms
Total Talk Time (AGENT): 162421 ms
Total Talk Time (CUSTOMER): 187080 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/d82830e2-a948-45d8-b879-be5d885dedd0_20250314T20:29_UTC.wav
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[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Thank you for calling. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office, check on a claim status.
[AGENT][NEUTRAL] OK [PII], I can help you with claim status. Can you please give me your callback number?
[CUSTOMER][NEUTRAL] Sure. That's [PII]. And that's a direct line.
[AGENT][POSITIVE] Thank you sir and
[AGENT][NEUTRAL] What's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Uh yes. Let me give you the policy number first. Is that OK? you want me to give you the name first?
[AGENT][NEUTRAL] No policy is fine.
[CUSTOMER][NEUTRAL] OK. That's 02549553.
[AGENT][NEUTRAL] OK, name and date of birth.
[CUSTOMER][NEUTRAL] The first name, [PII] Last name, [PII], [PII] The date of birth for the patient, [PII].
[AGENT][NEUTRAL] OK, let me pull them up real quick.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] OK and then what is the date of service of the claim and the charge amount?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] All right. Date of service, [PII].
[CUSTOMER][NEUTRAL] And the charge amount for the claim is gonna be
[CUSTOMER][NEUTRAL] OK, the total charges $21,248 even.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, that's $1,983 I guess. Just a moment. Let me check that exactly.
[CUSTOMER][NEUTRAL] Here we go. Let me open the primary OB.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Oh yes, that's yes, $1,983 the primary.
[CUSTOMER][NEUTRAL] For the primary pain.
[AGENT][POSITIVE] OK, thank you and then.
[AGENT][NEUTRAL] What is the name of the facility you're calling from [PII]?
[CUSTOMER][NEUTRAL] HCF Florida, Palm West Hospital.
[AGENT][NEUTRAL] I'm gonna put you on a brief hold while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] All right. Sure. Yes.
[AGENT][NEUTRAL] The
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding for me, [PII]. So I have the claim pulled up. The claim claim number is 355-0984.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim was denied because we need the explanation of benefits from the primary insurance carrier.
[AGENT][NEUTRAL] You there?
[CUSTOMER][POSITIVE] OK. Yes, I'm here. I'm sorry for that. I just put my mic in mute mute. I'm sorry.
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] All right. OK, just a moment. Let me check. I think there are multiple times we have been sent to the primary hobby. Let me check how was we submitted.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK. There are multiple times. There are, OK, they be sent on March.
[CUSTOMER][NEUTRAL] [PII] through fax [PII].
[AGENT][NEUTRAL] Yes sir, that's the right fax number. Let me look and see if I can just see anything that's come through.
[AGENT][NEUTRAL] I do. I see that they actually process the claim today. Let me, let me give you uh the new claim number.
[CUSTOMER][NEUTRAL] OK. And the
[AGENT][NEUTRAL] I do see that they did receive the information.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, the new claim number is 355-0984.
[CUSTOMER][NEUTRAL] A line.
[AGENT][NEUTRAL] The claim was paid $750.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] With check number 203.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 2905.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] 575203. I'm pulling it up now.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Claim was paid on [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The check number 203-2905.
[CUSTOMER][NEUTRAL] OK, just a moment. Let me, just my microphone, I mean.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. Yes, I'm here. So, can I have the check number again? Can you repeat me the check number, please?
[AGENT][NEUTRAL] 203-2905
[CUSTOMER][NEUTRAL] 203-2905.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, got it. All right. So the claim number is again 355-0984.
[AGENT][NEUTRAL] No, the new claim number is 357-520-3.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 203. OK.
[CUSTOMER][NEUTRAL] OK. The claim was paid with $750. So check number, I have that on [PII]. And is there any patient responsibility?
[AGENT][NEUTRAL] Uh, we don't give patient responsibility because that's determined by the provider.
[AGENT][NEUTRAL] So with that check, the maximum benefit for the data service was met.
[CUSTOMER][NEUTRAL] All right. OK, got it.
[CUSTOMER][NEUTRAL] Um, so.
[CUSTOMER][NEUTRAL] May I know what does the check cash, so cash? I think it might not be cashed yet.
[AGENT][POSITIVE] No, it was just right, it was just sent yesterday.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yesterday, OK. All right. Got it. So do you have the received and processed it for the claim?
[AGENT][POSITIVE] Yes, let me look for you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Received it on.
[AGENT][NEUTRAL] [PII] and processed it on [PII].
[CUSTOMER][POSITIVE] All right. Got it. Thank you.
[CUSTOMER][POSITIVE] So, yes. All right. Thank you so much for that. Now.
[CUSTOMER][NEUTRAL] OK. Can I have the call reference?
[AGENT][NEUTRAL] Yes, you can use my name [PII] in today's date.
[CUSTOMER][POSITIVE] [PII] and today's date. All right. [PII]. Got it. All right. Thank you so much for that, [PII], for helping me out today and hope you have a great day and happy weekend. Bye for now.
[AGENT][POSITIVE] Yes, happy weekend to you too, [PII]. Thank you for calling APL bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.