AccountId: 011433970860
ContactId: def7104a-b69d-442b-8457-1eda3f5f3524
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 424549 ms
Total Talk Time (AGENT): 172180 ms
Total Talk Time (CUSTOMER): 125425 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/def7104a-b69d-442b-8457-1eda3f5f3524_20250121T21:35_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. My last initial is [PII], calling on behalf of provider's office to check the claim status.
[AGENT][POSITIVE] OK, I'd love to help you with claim status today, [PII], do you mind if I get a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. And what's the member's policy number today?
[CUSTOMER][NEUTRAL] 017.
[CUSTOMER][NEUTRAL] 194.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 17
[CUSTOMER][NEUTRAL] M for Mike, L for Leo.
[CUSTOMER][NEUTRAL] Number 8.
[AGENT][POSITIVE] Thank you and.
[AGENT][NEUTRAL] Let's see, would you be able to verify for me please your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], and the last name is [PII] and the date of birth, [PII].
[AGENT][POSITIVE] Perfect. Thank you so much.
[AGENT][NEUTRAL] And 1 2nd.
[AGENT][NEUTRAL] What is the date of service on the claim we want to look at today?
[CUSTOMER][NEUTRAL] [PII] with the charge amount of $1,504 even. That is $1504.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Let's see if we can find that for you.
[AGENT][NEUTRAL] All right, would you be able to verify for me the name of the provider on file for this claim?
[CUSTOMER][NEUTRAL] Uh, it's, uh, Greater Florida Anesthesiologist LLC.
[AGENT][NEUTRAL] Perfect. And I do see that claim here. It looks like we received your claim on [PII]. We processed the claim on [PII], and it looks like that claim had um benefits payable of the $1,504. Um, 0, and I'm so sorry, your claim number is 3551131.
[AGENT][NEUTRAL] Um, the benefits were paid via a single check. The check number is 2022582, and I can get you check details if you need them.
[CUSTOMER][NEUTRAL] Uh, can you hold for one minute?
[AGENT][POSITIVE] Yeah, take your time.
[CUSTOMER][NEUTRAL] Yeah, the check number is 2022582.
[AGENT][NEUTRAL] 202-2582 yes.
[CUSTOMER][NEUTRAL] Yeah, what is the allowed amount?
[AGENT][NEUTRAL] Um, the benefit amount was the, the $1,504.
[CUSTOMER][NEUTRAL] That means total charge amount.
[AGENT][NEUTRAL] Yeah, and that's how much we paid out.
[CUSTOMER][NEUTRAL] You have, that is the allowed amount and paid amount, right?
[AGENT][NEUTRAL] Oh, well, we are a secondary insurance, so we don't have an allowed amount. We just have a benefit, um, and they were eligible for benefits up to $1,504 for this procedure.
[AGENT][NEUTRAL] But we don't, we don't negotiate price pricing.
[CUSTOMER][NEUTRAL] Yeah, you are the 2nd day.
[CUSTOMER][NEUTRAL] Yeah, what to do from my side to process this claim then?
[AGENT][NEUTRAL] I guess I don't understand.
[CUSTOMER][NEUTRAL] Uh, that means the, we got already, uh, the status is not covered from, uh, the, the, from the primary insurance.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] We already got the status from there and we have submitted the claim to secondary.
[AGENT][NEUTRAL] Yeah, and that was us and we paid it we paid $1,504.
[CUSTOMER][NEUTRAL] You're saying you already paid and
[AGENT][NEUTRAL] Yeah, we sent a check out um on, let's see, the check would have been put in the mail [PII], so a week ago.
[CUSTOMER][NEUTRAL] That mean you have the to our charge, sorry. The total bill amount is $1,504 and the total allowed and paid amount was $1,504 and the check number of 202258 582. Is it right, right?
[AGENT][NEUTRAL] Yep.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, OK. Uh, I don't, we don't have the UOB. Can you please send the UOB through fax?
[AGENT][POSITIVE] Yeah, I can. It probably hasn't made it through in the mail yet because it's only been a week, but I can absolutely fax it to you, no worries. Let me
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Get it pulled up for you.
[AGENT][NEUTRAL] And are you gonna want that made attention to yourself, [PII]?
[CUSTOMER][NEUTRAL] Yes. Attention to [PII].
[AGENT][POSITIVE] Perfect. And what is that fax number?
[CUSTOMER][NEUTRAL] Uh it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, I have that attention to [PII].
[CUSTOMER][NEUTRAL] Attention to my name, ma'am.
[AGENT][NEUTRAL] And then it's going to [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. How much time it will take to to reach us?
[AGENT][NEUTRAL] Oh yeah, so I'm hitting send on that right now as we speak, um, typically it takes 5 to 15 minutes for the fax to come through.
[CUSTOMER][NEUTRAL] Yeah, got it. And uh
[CUSTOMER][NEUTRAL] The claim number is 3551131. Is that right?
[AGENT][POSITIVE] Yes, absolutely.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, [PII], can I get the call reference number?
[AGENT][NEUTRAL] Yeah, you bet you. The call reference number is gonna be my name, [PII] to my last name [PII], and today's date.
[CUSTOMER][POSITIVE] OK, I I think that's it from my end and thank you for assisting me.
[AGENT][POSITIVE] Oh, it's my pleasure thank you for calling us at APL and I hope you have a fabulous day.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Thanks. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.