AccountId: 011433970860
ContactId: e0dc7f80-b726-48fc-bc93-94be6f4873de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 643809 ms
Total Talk Time (AGENT): 170269 ms
Total Talk Time (CUSTOMER): 178229 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/e0dc7f80-b726-48fc-bc93-94be6f4873de_20250207T19:24_UTC.wav
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[AGENT][POSITIVE] Thank you for calling. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, uh, this is [PII]. I'm calling from provider's office regarding a claim.
[AGENT][NEUTRAL] OK, and your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] Also, uh, can you please spell your name also?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Thank you, [PII]. Uh, the policy number is
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Polic policy number is 1071079.
[AGENT][NEUTRAL] OK, what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] How do
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][POSITIVE] No problem. Take your time.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] You know that
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for that and we're checking claim status.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what's the date of service in charge?
[CUSTOMER][NEUTRAL] Date of service is [PII]. Charge amount is $14,111 even.
[AGENT][NEUTRAL] OK, and what's the name of the provider?
[CUSTOMER][NEUTRAL] West Boca Medical Center.
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright, so I show that this claim was received.
[AGENT][NEUTRAL] Um, [PII] process [PII].
[AGENT][NEUTRAL] Uh, payment of $500 was issued, uh, made payable to the hospital.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] 1 2nd. 1 2nd.
[CUSTOMER][NEUTRAL] One second, one second. [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is the paid amount you said?
[AGENT][NEUTRAL] 500 even.
[CUSTOMER][NEUTRAL] $500. All allowed amount?
[AGENT][NEUTRAL] 500 is the maximum outpatient benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Her current
[CUSTOMER][NEUTRAL] So the allowed amount the same as $500. OK.
[AGENT][NEUTRAL] The benefit amount, not the allowed amount, the benefit amount is 500. That's what was paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any patient responsibility?
[AGENT][NEUTRAL] We do not determine patients responsibility.
[CUSTOMER][NEUTRAL] Is it paid through EFT or check?
[AGENT][NEUTRAL] It's an individual chat.
[CUSTOMER][NEUTRAL] Check number.
[AGENT][NEUTRAL] That check number is 2018321.
[CUSTOMER][NEUTRAL] Has it been cash?
[AGENT][NEUTRAL] One moment.
[AGENT][POSITIVE] I'm showing it's still outstanding.
[CUSTOMER][NEUTRAL] Uh, and it was issued on the same date, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The day that it was processed.
[CUSTOMER][NEUTRAL] OK. I need the copy of your for the claim. Can you send it to our fax?
[AGENT][NEUTRAL] Yeah, it was mailed to the address that's on your claim and it is now made available online so you can download it there um I can give you the website if you would like.
[CUSTOMER][NEUTRAL] And what's the website?
[AGENT][POSITIVE] It's secured, that's [PII]
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Do I need to register on this portal?
[AGENT][POSITIVE] Yes you do.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so the fax option is not available for you.
[AGENT][NEUTRAL] It is, but we've already mailed it to the address that's on your claim, and I'm just letting you know that it is, it's available to download from our online service center.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because it's already been mailed.
[CUSTOMER][NEUTRAL] Give me a second, please.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can you please confirm the address it is mailed to?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, the address it is sent to?
[AGENT][NEUTRAL] OK, go ahead and give me your address and I'll confirm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's the billing address that's on the claim?
[CUSTOMER][NEUTRAL] That's our mailing address.
[AGENT][NEUTRAL] OK, it goes to the billing address that's on the claim.
[CUSTOMER][NEUTRAL] Uh, and the
[CUSTOMER][NEUTRAL] So it is [PII]. Is it the address?
[AGENT][NEUTRAL] The billing address, I believe it's in [PII] of the claim.
[CUSTOMER][NEUTRAL] OK, then. Thank you. Uh, can I get the call reference number?
[AGENT][NEUTRAL] Can you go ahead and verify that billing address that's in [PII] of the claim?
[CUSTOMER][NEUTRAL] OK, then, uh, just give me a moment. I'll have to look for the claim form.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, it is [PII]. That is the billing address on the back box too.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm gonna send this back because I'm showing a [PII], but the one that you just verified is what I show on the claim as well so we'll send this one back.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, we'll verify.
[CUSTOMER][NEUTRAL] So you can use the fax option.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Can you use the fax option this time?
[AGENT][NEUTRAL] Well, it was sent to the incorrect address so we're gonna have to go back in and reissue the check we'll have to stop payment on this check and reissue another one and so then you'll get a copy of the of the explanation of benefits when it's reprocessed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, first verify if this one is cleared. I still show it outstanding, but we have to go to the proper channels and if it's reported that it has not cleared, they will void the check and then reissue a new check.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All [PII].
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] Uh, just the call reference number and the turnaround time it will take.
[AGENT][NEUTRAL] My name in today's
[AGENT][NEUTRAL] My name and today's date allow 5 to 7 business days.
[CUSTOMER][POSITIVE] OK then. Thank you.
[AGENT][POSITIVE] Alrighty thank you for calling APL. Have a good day.