AccountId: 011433970860
ContactId: ecb1144e-c9d4-4000-bf22-988a68037ae7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 767500 ms
Total Talk Time (AGENT): 123364 ms
Total Talk Time (CUSTOMER): 371034 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/ecb1144e-c9d4-4000-bf22-988a68037ae7_20250408T16:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. This is [PII] calling from
[CUSTOMER][NEUTRAL] Florida Mercy Hospital.
[AGENT][NEUTRAL] How can I help today, [PII]?
[CUSTOMER][NEUTRAL] Hello. Uh, yeah, actually, I'm checking on a denied claim. We have a denial regarding that claim.
[AGENT][NEUTRAL] Great, may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, if you need, I can provide you directly the claim number. I do have the claim number.
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] Uh, it's 351-3902.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, the patient's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you for that.
[CUSTOMER][NEUTRAL] And can you spell your name for me?
[AGENT][NEUTRAL] My name is spelled [PII].
[CUSTOMER][NEUTRAL] My
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Oh, OK, thank you so much for that.
[AGENT][NEUTRAL] All right. So this claim was received on [PII], denied on [PII].
[CUSTOMER][NEUTRAL] Uh, so.
[CUSTOMER][NEUTRAL] Yeah, sir. Just a moment. We do have that information. Uh, actually, the claim is uh denied for the primary UOB and we have sent the primary UOB.
[CUSTOMER][NEUTRAL] On one second.
[CUSTOMER][NEUTRAL] Yeah, which was sent to the fax number of [PII] on [PII].
[CUSTOMER][NEUTRAL] Uh, may I, may I know if this is the right fax number?
[AGENT][NEUTRAL] That is the right fax number.
[CUSTOMER][POSITIVE] That's the right
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you check from your end, uh, did you receive that primary UB or not?
[AGENT][NEGATIVE] No, we did not. We did not even receive the claim until October, so it needs to be resubmitted.
[CUSTOMER][NEUTRAL] receive the
[CUSTOMER][NEUTRAL] So it needs to be resubmitted.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] So you're stating that you are not able to receive that. OK, one second. So,
[CUSTOMER][NEGATIVE] Not yet received.
[CUSTOMER][NEUTRAL] So I'm going to send you the.
[CUSTOMER][NEUTRAL] It will be to
[CUSTOMER][NEUTRAL] Fax number 877.
[CUSTOMER][NEUTRAL] OK. Actually, uh, can I know how many claims do you handle for a call?
[AGENT][NEUTRAL] As many as you need me to check.
[CUSTOMER][NEUTRAL] And if you need me to check.
[CUSTOMER][NEUTRAL] Uh, actually, I do have
[CUSTOMER][NEUTRAL] Other
[CUSTOMER][NEUTRAL] OK. Uh, I do have other 4 claims and this is the same denial reason for the claim, so we have sent that. Could, I'll also provide you the other patient information, OK?
[AGENT][NEUTRAL] Let me notate this patient then we can check the next. One moment.
[CUSTOMER][NEUTRAL] Uh, can I get the, yes, yes, uh, I do have a small question. Is there any call reference number for a conversation for this number?
[AGENT][NEUTRAL] Call reference is my name with my last initial and then today's date. My name is [PII], last initial [PII], and then today's date.
[CUSTOMER][NEGATIVE] We lost credential and then JC.
[CUSTOMER][NEUTRAL] OK, [PII]. Thank you so much for that. One moment. I need to close this account. I need to go for the next 11 2nd.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yeah, I'll go for the next one.
[CUSTOMER][NEUTRAL] Uh, you know, directed the claim number or else, uh, I need to provide that the information?
[AGENT][NEUTRAL] Um, provide me the claim number, that's fine.
[CUSTOMER][NEUTRAL] Uh, the claim number is 3,504,880.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] name and date of birth.
[CUSTOMER][NEUTRAL] Uh, the patient's name is
[CUSTOMER][NEUTRAL] [PII]. The patient's first name is spelled as [PII] and the last name is [PII] And date of birth is [PII].
[CUSTOMER][NEUTRAL] And, and the last time we have sent that on the same day, [PII].
[AGENT][NEUTRAL] So we received the explanation.
[CUSTOMER][NEUTRAL] But this time we have sent it through. Oh yeah, yeah, please go ahead.
[AGENT][NEUTRAL] We received the explanation of benefits, however, it doesn't list the amounts applied towards the deductible co-pay or co-insurance. So we need a more detailed explanation of benefits.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] However
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Uh, I'm sorry. Uh.
[CUSTOMER][NEUTRAL] Can you repeat that? Did you receive that primary explanation of benefits?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, so, what additional information you are requesting again? Can I know that?
[AGENT][NEUTRAL] The explanation of benefits.
[AGENT][NEGATIVE] Does not list.
[CUSTOMER][NEUTRAL] the benefits.
[AGENT][NEUTRAL] The amount applied towards the deductible.
[CUSTOMER][NEUTRAL] The amount applied for the deduction.
[AGENT][NEUTRAL] Co-pay or co-insurance. We need a more detailed EOB.
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] We need a PayPal.
[CUSTOMER][NEUTRAL] OK, OK. So you're stating that you haven't received the deductible amount of the explanation of in which, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, OK. So I'm going to send you, we do have 2 primary explanation of benefits. So I'm going to resubmit that two primary explanation of benefits to the same fax number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yeah, OK. And there we go for the next next claim number was 356.
[CUSTOMER][NEUTRAL] 2843.
[AGENT][NEUTRAL] 356-084-3
[CUSTOMER][NEUTRAL] 0843. No, no. 3562843.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII]
[CUSTOMER][NEUTRAL] [PII] and the date of birth, July, sorry, [PII].
[AGENT][NEUTRAL] So looks like we have not received the explanation of benefits for this claim.
[CUSTOMER][NEUTRAL] We've not received an explanation for this claim.
[CUSTOMER][NEUTRAL] Oh shit, OK. So, OK, that's OK.
[CUSTOMER][NEUTRAL] Mhm. OK. I'm going to resubmit that.
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] The next claim number is 35.
[CUSTOMER][NEUTRAL] 22
[CUSTOMER][NEUTRAL] 898.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh well but.
[CUSTOMER][NEUTRAL] [PII] Date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, so it looks like we haven't received explanation and benefits for this one either.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, I did receive that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next one was, the next claim number was 356.
[CUSTOMER][NEUTRAL] 963-3.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Name and date of birth.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] The patient's first name is
[CUSTOMER][NEUTRAL] [PII], and the last name is [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] Oh, sorry. Uh, [PII].
[AGENT][NEUTRAL] Thank you. So we have not received any explanation of benefits for this claim.
[CUSTOMER][NEUTRAL] OK. We have seen that one, you're stating that you're not yet received. So I'm going to send all of this one and I do have 11 last number. Uh, the claim number is
[CUSTOMER][NEUTRAL] 3563048.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And on this one.
[CUSTOMER][NEUTRAL] The patient's name was [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, sorry? Yeah, the patient's name was called well. Date of birth [PII].
[AGENT][NEUTRAL] Go ahead with patient name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, yeah. The patient name [PII]. Date of birth [PII].
[AGENT][NEUTRAL] No EOB for this one either.
[CUSTOMER][NEUTRAL] Oh shit, OK.
[CUSTOMER][NEUTRAL] Mhm. One second.
[CUSTOMER][POSITIVE] Yeah, thank you so much for that information. I'm going to send you all of this EOB set a time for the fax number of
[CUSTOMER][NEUTRAL] 877
[CUSTOMER][NEUTRAL] [PII]. Is that OK?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, that is, we do have. Uh, we need to mention any attention to claims department or else do you need me to mention anything else?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Attention claims is all.
[CUSTOMER][POSITIVE] OK. OK, thank you, thank you so much for that information. Have a good day. Bye-bye.
[AGENT][NEUTRAL] You too. Bye-bye.