AccountId: 011433970860
ContactId: e2592ed7-8055-4947-a572-7e836637a8fb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1482969 ms
Total Talk Time (AGENT): 308710 ms
Total Talk Time (CUSTOMER): 243492 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/e2592ed7-8055-4947-a572-7e836637a8fb_20250402T15:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] This is
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check up on your claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status and you said your name was [PII]?
[CUSTOMER][POSITIVE] [PII].
[AGENT][NEUTRAL] OK, can you spell your name for me please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Thank you so much and then what is your callback number sir just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. It will be [PII]. It's a direct line, there is no extension.
[AGENT][POSITIVE] OK, thank you so much. I appreciate you giving me that information and then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] The patient name for this one will be [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the policy number, please?
[CUSTOMER][NEUTRAL] OK. Policy ID for this one is
[CUSTOMER][NEGATIVE] It's too long.
[CUSTOMER][NEUTRAL] OK. So the policy ID is 01648436.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK and then can you please give me the data service and the charge amount?
[CUSTOMER][NEUTRAL] OK, just hold on. The date of service is [PII]. Total charge amount for this one will be $6,391 even. It was billed via paper.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEGATIVE] No, primary insurance didn't pay anything.
[AGENT][NEUTRAL] OK, and can you please give me the name of the facility you're calling from, sir?
[CUSTOMER][NEUTRAL] CJW Medical Center.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while.
[AGENT][NEUTRAL] Name and I'll
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Thank you, Bravo.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me Bravo. I have the claim information for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3562205.
[AGENT][NEUTRAL] The claim was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK. I do see the pri uh primary was already being sent.
[CUSTOMER][NEGATIVE] It was last sent back on.
[CUSTOMER][NEUTRAL] [PII]. Yesterday only.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, well, we haven't received it yet, yet then.
[CUSTOMER][NEUTRAL] OK. So for this one,
[CUSTOMER][NEUTRAL] What, uh, how much time needs to be allowed?
[AGENT][NEUTRAL] 7 to 15 business days it takes to process the claim.
[CUSTOMER][NEUTRAL] And what is the claim received it?
[AGENT][NEUTRAL] We received it on.
[AGENT][NEUTRAL] [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That was the day it was processed.
[AGENT][NEUTRAL] Wait, wait, wait, I'm sorry, I apologize, we received it on [PII].
[AGENT][NEUTRAL] And processed it on [PII]. I apologize.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], right.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] Is there anything else I can help you with before we go, Bravo?
[CUSTOMER][NEUTRAL] Yes, I do have 2 more things to check up on. Do you have time for that?
[AGENT][NEUTRAL] OK, can you give me the next member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. Just hold on for a moment.
[AGENT][POSITIVE] Yes sir, go ahead and take your time.
[CUSTOMER][NEUTRAL] The call reference number will be same, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] What will be the call reference number?
[AGENT][NEUTRAL] It's my name, [PII] and today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And just let me know when you're ready for the next member.
[CUSTOMER][NEUTRAL] Yes, I'm just pulling up that one.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, I got the next one.
[AGENT][NEUTRAL] OK. What's the member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] And it is
[CUSTOMER][NEUTRAL] It is for uh, it is for a different provider actually.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK. And then what is the policy number?
[CUSTOMER][NEUTRAL] Policy ID is 02450166 ML 7.
[AGENT][NEUTRAL] OK, let me look that policy up real quick.
[AGENT][NEUTRAL] And then can you please give me the data service and the charge amount?
[CUSTOMER][NEUTRAL] Yes, sure, just hold on.
[CUSTOMER][NEUTRAL] OK, so the date of service is [PII].
[CUSTOMER][NEUTRAL] Total charge amount will be $5680 even. It was billed via paper.
[AGENT][NEUTRAL] OK, and then what's the charge amount after the primary insurance paid their part?
[CUSTOMER][NEGATIVE] primary didn't pay anything.
[AGENT][NEUTRAL] OK, and the amount was $5600?
[CUSTOMER][NEUTRAL] For the charged amount, right?
[AGENT][NEUTRAL] Yeah, the chart, the bill amount was 5600.
[CUSTOMER][NEUTRAL] $5680 even. 5680.
[AGENT][NEUTRAL] 5680. OK. And what's the name of the facility, please?
[CUSTOMER][NEUTRAL] It's a Florida University Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim and I'll be right back.
[CUSTOMER][NEGATIVE] Yeah. You are on hold.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I have this claim ready for you.
[AGENT][NEUTRAL] The claim number is 3563616.
[AGENT][NEUTRAL] And the claim was denied for the same reason we need the EOB from the primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For this one also, the primary UB was also sent.
[CUSTOMER][NEGATIVE] And it was sent back last on the same actually, yesterday only.
[AGENT][NEGATIVE] Haven't received it yet.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you need to allow 10 to 15 business days, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK. What is the claim received date?
[AGENT][NEUTRAL] Claim was received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm just pulling up the next one. Hold on for a moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] Just hold on, actually, my system is still loading.
[AGENT][NEUTRAL] That's OK. I understand. I have problems sometimes with mine.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, I got that one.
[CUSTOMER][NEUTRAL] OK. So for this one, it is for
[CUSTOMER][NEUTRAL] Or different providers.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the patient name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And what is the patient's policy number?
[CUSTOMER][NEUTRAL] It is 02486619 ML 8.
[AGENT][NEUTRAL] OK, let me pull that one up.
[AGENT][NEUTRAL] OK, and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[CUSTOMER][NEUTRAL] Total charge amount for this one will be $9846 even.
[AGENT][NEUTRAL] $9,846 is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and then what is the
[CUSTOMER][NEGATIVE] And for this one also, no.
[AGENT][NEUTRAL] No primary, OK.
[CUSTOMER][NEGATIVE] Primary insurance didn't pay anything.
[AGENT][NEUTRAL] OK, and what is the um name of the facility for this one?
[CUSTOMER][NEUTRAL] Visits Florida West Side Hospital.
[AGENT][POSITIVE] OK, I'm gonna put you on a brief hold again. I'm gonna pull up this claim for us, Bravo, and I'll be right back.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] Yeah. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you very much for holding for me. I have this claim information for you. The claim number is 352-6875.
[AGENT][NEUTRAL] And this claim was also denied needing the EOB from the primary insurance.
[CUSTOMER][NEUTRAL] OK. So for this one, I do see.
[CUSTOMER][NEUTRAL] The primary UP was sent back on.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Could you please check this one?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I take this back for review.
[AGENT][NEUTRAL] Yes, we have not received the EOB for that one. the information that was sent was the same information that was sent on the first one without the EOB and it just, uh, said that it was a duplicate, so we'll need the EOB for this one from the primary insurance.
[AGENT][NEUTRAL] Showing that they paid their part.
[CUSTOMER][NEUTRAL] So, primary U is needed for this, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK. What will be the
[CUSTOMER][NEUTRAL] Flame received it
[AGENT][NEUTRAL] The claim was received.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, my, I'm sorry, my computer is trying to search for it. I can hear you.
[CUSTOMER][NEUTRAL] Yes, sure.
[AGENT][NEUTRAL] It's gonna be just a second while it tries to pull itself back up again. I'm sorry.
[AGENT][NEUTRAL] OK, this one was received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Processed on which date you, sir?
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what will be the, the primary UV needs to be sent via fax, right?
[AGENT][NEUTRAL] Yes, you can fax it. Do you have the fax number?
[CUSTOMER][NEUTRAL] No, I do not have. What will the fax know?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The claim number for this one it will be
[CUSTOMER][NEUTRAL] Ending with 6875, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. The call reference number is the same, right?
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] Yes, sir, it is. Yes, sir.
[CUSTOMER][POSITIVE] And thank you so much for your assistance, [PII].
[AGENT][POSITIVE] You're very welcome. You too, [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] You have a wonderful day.
[CUSTOMER][NEUTRAL] No, that's it for this call.
[AGENT][POSITIVE] OK, you have a beautiful day and thank you for calling APL.
[CUSTOMER][NEUTRAL] Bye-bye.