AccountId: 011433970860
ContactId: ea19be03-9478-4227-a7f2-9e5dc6a1afc5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 968039 ms
Total Talk Time (AGENT): 362207 ms
Total Talk Time (CUSTOMER): 357011 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/ea19be03-9478-4227-a7f2-9e5dc6a1afc5_20250422T17:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[CUSTOMER][NEUTRAL] [PII], this is [PII] on the care team. Now, you might not be too happy with me after this call, but
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] I have a script reader on the line and their claim was denied for be notice and I read them the, you know, the little remark in Google for providers. She still didn't understand. I tried to explain it. Well, I just said what the statement said just in different words. She still didn't get it. So then I offered to send an email to [PII] for [PII] to call and explain it to her. That's what they said on the Google card and she's just like, well,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Um, yeah, get me to your supervisor. I'm like, oh, you wanna speak to my supervisor. So [PII], um, is having issues with her phone, but she said to get the lady to claim support to talk, she just doesn't understand being noticed.
[CUSTOMER][NEUTRAL] And she's saying we only have one company and one name and I said well that has to be resolved with the IRS and then send us the updated information and we can you know continue with the claims so.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] That's all. She just doesn't get be noticed and I don't think she unders that's it. You still my friend?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Got you.
[AGENT][POSITIVE] Yeah, I got you. Is there anything you can do both out of your hands. Go ahead and give me a callback.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] that her number on the screen?
[CUSTOMER][NEUTRAL] OK, it's um.
[CUSTOMER][NEUTRAL] No, it's [PII].
[AGENT][NEUTRAL] And what's her name?
[CUSTOMER][NEUTRAL] Her name is [PII].
[AGENT][NEGATIVE] [PII]. I've talked to [PII] before. She's not pleasant. She can be kind of snotty.
[CUSTOMER][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] That's the truth.
[AGENT][NEUTRAL] What's um, what's the policy number?
[CUSTOMER][NEUTRAL] Um, it is 2203926.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And let me get the claim information which.
[AGENT][NEUTRAL] And that's for Mr. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And is it that claim end in 1901?
[CUSTOMER][NEUTRAL] And it's
[CUSTOMER][NEUTRAL] Wait a minute. 1901 is one of them. Is that the one with the marker or is it uh 3048?
[AGENT][NEUTRAL] Yeah, that's the one with the B notice. Mhm.
[CUSTOMER][NEUTRAL] OK, yeah, that's it.
[AGENT][NEUTRAL] I see if you know that's HCA Florida University, right?
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] Yes, the other one I have is the original. All right.
[CUSTOMER][NEUTRAL] Because they sent it in and we asked for the um explanation of benefits and then this one here is the second one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm just gonna.
[AGENT][NEUTRAL] Take that 10 down and.
[AGENT][NEUTRAL] And the patient information's been verified right [PII]?
[CUSTOMER][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] OK, OK, you can send her on through and I'll see if I can.
[AGENT][NEUTRAL] Assist her further
[CUSTOMER][POSITIVE] Enlighten
[CUSTOMER][POSITIVE] All right. Thanks, [PII]. Have a good day.
[AGENT][POSITIVE] You too [PII] thank you.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Hello, [PII].
[CUSTOMER][POSITIVE] Thank you so much for holding. I have [PII] on the line and she'll be assisting you further, OK?
[CUSTOMER][NEUTRAL] Yes, go ahead.
[AGENT][NEUTRAL] Hi [PII].
[AGENT][NEUTRAL] Can you hear me OK? Hi.
[CUSTOMER][NEUTRAL] Hey hi.
[AGENT][NEUTRAL] So, um, my name, my name is [PII]
[CUSTOMER][POSITIVE] Yes, I can.
[AGENT][NEUTRAL] And I'm on the claims support team.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I understand you have some questions in regards to the denial for this uh patient service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] How can I help you? What's the question?
[CUSTOMER][NEUTRAL] So, actually, uh, we made a call and I'll just explain to you in a brief moment. Give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And I can give you the call reference as well.
[CUSTOMER][NEUTRAL] And uh previously on [PII], when I called and I spoke with [PII], she stated like they received the claim on [PII] and they denied on [PII] and they stated like denied for the primary OB needed to process the claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And they gave the provider, uh sorry, fairer fax number and attention to claims department.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So we have send the primary EOB.
[CUSTOMER][NEUTRAL] And now, uh, when I spoke with [PII], it's stating like, uh, we need to contact with the IRS to fix the issue with the tax ID. So I don't know because, uh, previously, we got all the information and we do have the claim number with us, right? So firstly, only you should deny it for it. But after sending the primary you being.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And now stating as they won't be able to process the claim because uh it is denying for IRS issue. So may I know now it's going to process the claim or it's going to be denied?
[AGENT][NEUTRAL] OK, so actually what happened, [PII] is we did receive the claim, so we initially did receive it, um, and we're speaking of that, uh, [PII] for the emergency room visit, is that right?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, OK, so we did previously receive the claim and we requested the explanation of benefits so then when we received the explanation of benefits when we went to process the claim, we had a notice in our system that the vendor um information doesn't match and what that means is there is an issue with the tax ID number and it must be addressed with the IRS.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So you should have received a letter that would instruct you what steps need to be taken so I'm sure you wouldn't handle it would have to go to someone in uh possibly who handles that information within your facility, OK?
[AGENT][NEUTRAL] Um, and so what happens is
[CUSTOMER][NEUTRAL] OK. I just need to
[AGENT][NEUTRAL] Yeah, we're unable to process that to the provider due to the issue with the tax ID number so actually what happened with this claim is the benefits for that service were mailed to the insured.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you tell me, um, just give me one moment. So there was, I'm gonna pull up that that claim information bear with me for just one moment please.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] So basically what this letter means is that um it would have went to like I said your facility and whoever handles this it it lets you know that there is an issue received from the IRS we received a notice from the IRS, the Internal Revenue Service, that the name and taxpayer ID number on your account with us is incorrect.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So you have to resolve the discrepancy um within your your department. So whoever handles that would need to address that with the IRS, OK?
[CUSTOMER][NEUTRAL] Uh, just let me know IRS means what.
[AGENT][NEUTRAL] Internal Revenue Service.
[CUSTOMER][NEUTRAL] In
[AGENT][NEUTRAL] Revenue service.
[CUSTOMER][NEUTRAL] OK. Just give me a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thank you so much for being online.
[CUSTOMER][NEUTRAL] So, actually, uh, yes, and it is Internal Revenue Service, right? So, just stating that uh the facility is also not enrolled with the state Medicare, I guess.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Am I correct with this?
[AGENT][NEUTRAL] Yeah, can you repeat that last part?
[CUSTOMER][NEUTRAL] And actually, when I look on it,
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yes, yes. Actually, when I looked with our NBA also, and it was not enrolled with the state Medicaid. Am I correct with this?
[AGENT][NEUTRAL] Um, it doesn't have anything to do with Medicaid. It has to do with the Internal Revenue Service. So there's a problem with the tax ID for the HCA Florida University Hospital.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there was a letter that was sent um in regards to what the problem is and how it needs to be fixed so you need to get with your your uh business office or or possibly the business office or maybe your um your other uh administrative personnel that can clear this information up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there um
[AGENT][NEUTRAL] Is there a fax number I can fax you the letter that was sent?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yup, sure. Uh, it will be fine. Uh, so it will be [PII].
[AGENT][NEUTRAL] And that's the fax number I can send it to?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Uh, thank you so much. Sorry. It is [PII].
[AGENT][NEUTRAL] Is that
[AGENT][NEUTRAL] Yeah, OK, that's the number I have. OK, so I verified that I can send a copy of the letter that was sent. I can fax that over now in the meantime, um, [PII], what happened with this claim is it looks like you were expecting a reimbursement of $1,06.80 is that right?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so, um, what happens in this situation is when that claim, um, when that claim cannot be, uh, we cannot assign the benefit due to this issue with the tax ID number, we pay that benefit to the insured.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So the uh, the, the insured received the payment for that data service.
[AGENT][NEUTRAL] And we set a check in the amount of 1, 16 and 80 cents, OK?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK, you pay to the insured member.
[AGENT][POSITIVE] Yes, we pay to the insured member. That's right.
[CUSTOMER][NEUTRAL] Give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much for being online. Uh, so, actually, may I know uh when it was paid to the member?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] The same day we process your claim on [PII].
[CUSTOMER][NEUTRAL] OK, uh, with the total amount we bill, right?
[AGENT][NEUTRAL] Yes, $1,006.80.
[CUSTOMER][POSITIVE] OK. Uh, thank you so much for this information. We'll just, uh, get in touch with you once again after getting this issue resolved. So already you have paid, right? So we'll just touch with the number, OK? So just may I know the call reference number for this call and end up with this call, OK?
[AGENT][NEUTRAL] Certainly.
[AGENT][POSITIVE] Yes, [PII], um, the call reference number you would use my name [PII] My last initial [PII].
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And uh if you have paid, uh just let me know the uh the claim number will be changed for the paid information, right?
[AGENT][NEUTRAL] That's right, mhm.
[AGENT][NEUTRAL] The claim number was 35.
[AGENT][NEUTRAL] 91
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 903.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And again that was 421-2025.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, it was sent via EFT or check.
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] EFT you have paid or you or you have checked via uh sorry, you have paid via check.
[AGENT][NEUTRAL] Yeah, it was a check, it was a check. Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Check number, please.
[AGENT][NEUTRAL] Oh, I can't give you the check number because it wasn't issued to you. I can just tell you the claim number and the amount and what date it was paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so just uh let me know uh once you please cancel the check because it's not yet, uh, yet in cash, right? So we'll fix the issue and we'll get back to you. Is that will be fine with you?
[AGENT][NEUTRAL] I'm sorry, you want further information on the check that there's no other information to give you like I said, it was paid to the member.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And it was paid on [PII] for the coinsurance amount of 1680 cents on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, no issue. Thank you so much for this information. Have a great day ahead.
[AGENT][POSITIVE] You too [PII] thank you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Bye bye. Did you have any other questions?