AccountId: 011433970860
ContactId: ef6258e5-7f9f-45b1-96d4-785a8a8968bd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 319799 ms
Total Talk Time (AGENT): 131021 ms
Total Talk Time (CUSTOMER): 119477 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/ef6258e5-7f9f-45b1-96d4-785a8a8968bd_20250314T15:55_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, and I'm calling from a hospital in [PII]. I'm calling to see if you received the claim that was submitted for a patient of ours.
[AGENT][NEUTRAL] OK, I can definitely check and see if the claim has been received. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] My name is [PII], that's [PII]
[CUSTOMER][NEUTRAL] And my telephone number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Members policy number is let me see, would that be the cert number on the card?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, certain number is 02473097 M as in Mary, L as in Lucky 7.
[CUSTOMER][NEUTRAL] Or 8 for outpatient, yeah.
[AGENT][POSITIVE] Thank you. And can you
[AGENT][NEUTRAL] OK, can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Congratulations to Versace.
[AGENT][NEUTRAL] And what's the total bills?
[CUSTOMER][NEUTRAL] Total bill is $4,579.87.
[AGENT][NEUTRAL] OK, hold on one moment, we received a few claims. Um, let me see which one is yours. Hold on one second, OK?
[CUSTOMER][POSITIVE] Thank you, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And what's the name of the provider's office?
[CUSTOMER][NEUTRAL] It is Broward Health Imperial Point.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Now I got the right provider. Now let me get the right total bill. Hold on one second.
[CUSTOMER][POSITIVE] It's OK, take your time.
[AGENT][NEUTRAL] So it has to be this one.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so what's your tax ID?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, um, hold on one moment.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Because we received the claim, it is the same provider, but it's a different total bill than yours.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's the same tax ID. Did you want me to, this is the only, this is the only claim from Broward for that data service. Did you want me to give it to you?
[CUSTOMER][NEUTRAL] What was the amount of the claim that you received?
[AGENT][NEUTRAL] Let me see. This one is
[AGENT][NEUTRAL] $13,670.02.
[CUSTOMER][NEUTRAL] Hold on a minute. Let me see, uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You're right, it's 13,000. I gave you the expected payment. I apologize.
[AGENT][NEUTRAL] Oh, it's OK, no worries at all. OK, so we received this claim on [PII].
[AGENT][NEUTRAL] Uh, let me get the claim number for you. Hold on one moment.
[AGENT][NEUTRAL] The claim number is 356-737-6.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the maximum benefit for the data service has been met.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Now, um, is this a balance that can go to the patient now or?
[AGENT][NEUTRAL] Well, since we're not the major medical, we don't, um, we don't provide patient responsibility or determine patient responsibility, um, that would be between either primary and provider or you as a provider, whatever your policies are outstanding balances.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][POSITIVE] OK great and I appreciate your help um and I'm assuming a letter reconsideration is going out for that?
[CUSTOMER][NEUTRAL] Or has gone out for that?
[AGENT][NEUTRAL] Uh, not for reconsideration, like you mean like the explanation of benefits?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, do you have a reference number for the call?
[AGENT][NEUTRAL] Um, so there's no call reference number, but you can use my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK great I appreciate your help thank you so much you have a good weekend.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. Was there anything else I can help you with?
[CUSTOMER][POSITIVE] No, just that one. Thank you, [PII].
[AGENT][POSITIVE] Alright, thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Uh bye bye.