AccountId: 011433970860
ContactId: e7c8890d-8097-4b5f-9100-438a908b3037
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 353239 ms
Total Talk Time (AGENT): 165555 ms
Total Talk Time (CUSTOMER): 137236 ms
Interruptions: 4
Overall Sentiment: AGENT=2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/e7c8890d-8097-4b5f-9100-438a908b3037_20250114T20:48_UTC.wav
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[AGENT][POSITIVE] Hi, thank you so much for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. Good afternoon. My name is [PII]. I'm calling from South Miami Hospital.
[AGENT][NEUTRAL] Hi [PII], how can I help you?
[CUSTOMER][NEUTRAL] Uh, may I have the initial of your last name? Good, and you?
[AGENT][POSITIVE] Oh yes, it's [PII]. I'm wonderful thanks.
[CUSTOMER][NEUTRAL] OK, you spell [PII]?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK, I'm calling again from South Miami Hospital. We billed you guys a claim in September and we haven't received any response, so I'm not sure whether you have it or not.
[AGENT][POSITIVE] Yeah, I'd love to look into that for you, Ms. [PII]. Do you mind if I really quick get a good call back number for you?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you, and then the member's policy number?
[CUSTOMER][NEUTRAL] 01603009 M as in Mary, L like Larry, 8.
[AGENT][POSITIVE] Thank you, I appreciate that. Give me one moment to get this policy up.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And would you be able to verify for me, pretty please your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], uh, [PII].
[AGENT][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Service day was [PII].
[AGENT][NEUTRAL] Yeah, OK, I see that.
[CUSTOMER][NEUTRAL] And the on belt.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I'm pretty sure I see this claim for you. Um, hang tight one second. I just need to.
[AGENT][NEUTRAL] Moved to a different part of my screen.
[AGENT][NEUTRAL] Alright, and then it looks like I received this claim.
[AGENT][POSITIVE] I'm so sorry.
[AGENT][NEUTRAL] I spoke to you soon. It looks like I show it on 10-21-2024 and we processed it 10-23-2024. I have your claim number listed as 352-0988.
[AGENT][NEUTRAL] And I show the claim had benefits payable of $52.23. It looks like it was paid via check with the check being 2010039 and I.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold on 20,100.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 39
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] 39. I'm sorry.
[CUSTOMER][NEUTRAL] For 5223.
[CUSTOMER][NEUTRAL] 29
[AGENT][NEUTRAL] For, yes, uh, 2010039 for 5223.
[CUSTOMER][NEUTRAL] OK, and then, OK, but I don't have that payment.
[AGENT][NEUTRAL] Alright, let me pull up the check details real fast.
[CUSTOMER][NEUTRAL] Let me see, hold on, let me check.
[CUSTOMER][NEUTRAL] Let me check, let me check.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I show that the check was issued [PII] and it was cleared on [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It went to South Miami Care Inc at [PII].
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, no, no, no, no. What is that?
[CUSTOMER][NEUTRAL] That's not our address. You guys know where, where, where it goes? Are you sure that you're not sending it to the physician instead of us?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] They, it's supposed to, I mean, let me pull up the claim real quick I think it goes to whatever like that.
[CUSTOMER][NEUTRAL] And now it's supposed to be the [PII] supposed to go to [PII]. Let me see, [PII].
[CUSTOMER][NEUTRAL] No, [PII], we're in [PII].
[AGENT][NEUTRAL] Sorry, it's all loading still.
[AGENT][NEUTRAL] Alright, so that is on the claim form, the remit address um provided to us in [PII].
[CUSTOMER][NEUTRAL] OK, then you're no, no, then that, that must be the physician claiming is that a UB or a HEPA form.
[AGENT][NEUTRAL] Oh it might I guess maybe this isn't your claim um it was.
[AGENT][NEUTRAL] South, I guess I thought South Miami Hospital.
[CUSTOMER][NEUTRAL] Right, because the doctors are subcontracted to come to the hospital, so they do their own billing separately.
[AGENT][NEUTRAL] Is it not the same?
[AGENT][NEUTRAL] OK, so then that's what this is. I'm so sorry so actually I don't have any claim on file otherwise.
[CUSTOMER][NEUTRAL] I thought so. OK, so let me have your fax.
[AGENT][POSITIVE] I'm so sorry.
[CUSTOMER][POSITIVE] No, no problem. Let me have your fax number real quick.
[AGENT][NEUTRAL] Yes, absolutely, it is [PII].
[CUSTOMER][POSITIVE] Perfect. Thank you so much. I will be sending the, OK.
[AGENT][POSITIVE] My pleasure. I'm really sorry about that.
[CUSTOMER][POSITIVE] No, no problem. Hey, you're not the only one that has ever gotten confused, believe me, because these doctors do their own billing separately, yeah, yeah, and they just, they come and go and they do their own thing, thank [PII].
[AGENT][POSITIVE] Yeah, send it on to us and we will get it all taken care of for you.
[AGENT][POSITIVE] I just saw this South Miami and I was like yes.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Perfect well I'm glad you were like hey that's not right, and we figured it out, um, and we don't have a timely filing limit so please send that to us and we'll do our best to take care of you.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] No problem. Thank you so much. Have a wonderful afternoon.
[AGENT][POSITIVE] My pleasure. You too, take care.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Bye bye.