AccountId: 011433970860
ContactId: dbb8b1a9-205d-4ab5-abcb-6419dfd1f056
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 414359 ms
Total Talk Time (AGENT): 142014 ms
Total Talk Time (CUSTOMER): 108779 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/dbb8b1a9-205d-4ab5-abcb-6419dfd1f056_20250108T13:30_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. I'm calling for the provider Florida Woman Care. Please note that this call will be monitored record for quality and training purposes. I'm calling to check on the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status, and [PII], how many claims do you have today in total?
[CUSTOMER][NEUTRAL] I do have only one with me.
[AGENT][NEUTRAL] Alright, and may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure, the contact number I have [PII] is a direct line extension.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[AGENT][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Yup, it is 019.
[CUSTOMER][NEUTRAL] ready for that?
[AGENT][POSITIVE] Yes, I'm ready.
[CUSTOMER][NEUTRAL] Yeah, it is 01973204 M. Mike L Lima, and the number 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is [PII] on the day of [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yup. date of service I'm showing [PII] and the total charge amount, $6750 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] And um what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] This one [PII] woman get LLC.
[AGENT][NEUTRAL] OK this isn't it. Hold on one moment. And [PII], do you mind if I place you on just a brief hold while I locate your claim?
[CUSTOMER][NEUTRAL] Sure, yep.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] That's not even a provider.
[AGENT][NEUTRAL] 4443.
[AGENT][NEUTRAL] Maybe he's saying [PII] Women care.
[AGENT][NEUTRAL] Here we go.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes I'm there.
[AGENT][POSITIVE] All right, thank you so much for holding. I apologize for that wait. So I am showing that the um claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 4443.
[AGENT][NEUTRAL] And on [PII], the claim was paid out on to the provider.
[AGENT][NEUTRAL] Um, a total of $194.69.
[CUSTOMER][NEUTRAL] OK. So that's allowed on the paid amount, right?
[AGENT][NEUTRAL] Let me see what this code is. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, with that payment, the maximum benefit um for the data service has been met.
[CUSTOMER][NEUTRAL] OK, so the balance is $11.43 apply to the provider right of like that, the balance bill amount.
[AGENT][NEUTRAL] Can you say that one more time slowly?
[CUSTOMER][NEUTRAL] Uh, yeah, the balance $11.43 apply to the provider right off like that.
[AGENT][NEUTRAL] Are you asking like responsibility?
[CUSTOMER][NEUTRAL] Uh, no, like the primary leftover amount is $206.12 and you pay like 194. 69 cents. So the balance is $11.43 applied to the provider contractual discount like that.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] The $11.43 is an outstanding balance, so it would be up to you as a provider and primary to determine if it's patient responsibility or if whatever your protocol is for outstanding balances at that point, but I don't under it's not because of the provider's contract, it's the patient's policy.
[CUSTOMER][MIXED] OK, but there is no re list on this claim, right?
[AGENT][NEUTRAL] There's no what? Say, can you say that one more time? I didn't hear you.
[CUSTOMER][NEUTRAL] There is no
[CUSTOMER][POSITIVE] Yeah, there is no denial on this claim, correct? It's got fully paid.
[AGENT][NEUTRAL] There's no denial. No, there's no denial on the claim, no.
[CUSTOMER][NEUTRAL] OK, got you. May I have the mailing address for my documentation purpose.
[AGENT][NEUTRAL] Sure, so it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEGATIVE] OK. And the family, family following limit for nothing.
[AGENT][NEUTRAL] For an appeal is 180 days from the denial date.
[CUSTOMER][NEUTRAL] OK. May I have the call reference number for this one?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date, which is [PII] The [PII] is [PII], and then today's date.
[CUSTOMER][NEUTRAL] All right. Also this claim received and paid on the same rate, same date, correct? [PII].
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] All right, thank you for listening. Have a great day. Bye-bye and stay safe.
[AGENT][POSITIVE] Thank you and thanks for calling APL. I hope you have a great day as well. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.