AccountId: 011433970860
ContactId: f0078037-dac9-45c5-a04b-bad07396933a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 482630 ms
Total Talk Time (AGENT): 109947 ms
Total Talk Time (CUSTOMER): 199180 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/f0078037-dac9-45c5-a04b-bad07396933a_20250410T13:41_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. This is [PII] calling from University of Miami to check on a claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yup. It will be [PII] with the extension of [PII].
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] OK, thank you. And do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yeah, sure. It will be 01823358. M as in Mike, L as in Larry, 8.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Remember's first name will be [PII]. Last name will be [PII]. Date of birth will be [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And date of service.
[CUSTOMER][NEUTRAL] D of service will be [PII] with the billed amount of 2, it will be [PII] with the bill amount of $299 even.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] By the way, how are you doing today, [PII]?
[AGENT][POSITIVE] I'm doing good. How are you?
[CUSTOMER][POSITIVE] Yeah, good to hear. They're doing good as well.
[AGENT][NEUTRAL] OK, what was the total charges on that again? Sorry about that.
[CUSTOMER][POSITIVE] No worries, it will be $299 299 dollars.
[AGENT][NEUTRAL] OK, I, I, I have a claim for that date, but that's not the total bill charges. Um, who is the provider on that?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Provider will be?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So, [PII].
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] By the way, we actually submitted the claim on [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Previously I've called. Mhm.
[AGENT][NEUTRAL] Yeah, it doesn't look like I have a claim for that date of service, I mean for that build amount.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No worries, ma'am. Mhm. May I know the members affected your term as well?
[AGENT][NEUTRAL] Effective date is [PII], and the policy is currently active. There's no term date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, OK, perfect. May I know the payer ID?
[AGENT][NEUTRAL] Pay your ID is 60801.
[CUSTOMER][NEUTRAL] 60801, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] May I know the mailing address?
[AGENT][NEUTRAL] Mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it. OK. May I know the time limit?
[AGENT][NEGATIVE] And there's no timely filing limit.
[CUSTOMER][NEUTRAL] No time limit, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, perfect. uh.
[CUSTOMER][NEUTRAL] OK. May I know the fax number?
[AGENT][NEUTRAL] Fax number is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just to confirm [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Can I get the call reference number as well?
[AGENT][NEUTRAL] Uh, it's just my name, [PII], first initial to last name, [PII], today's date.
[CUSTOMER][NEUTRAL] By the way, I still have 2 more claims. Can you please submitted that.
[AGENT][NEUTRAL] OK. Is this for the same patient or a different one?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It's for a different patient.
[AGENT][NEUTRAL] OK. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next member ID will be 1480.
[CUSTOMER][NEUTRAL] 324 M as in Mike. L as in Larry, 8.
[CUSTOMER][NEUTRAL] Don't
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You have the patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it will. My first name will be [PII], last name will be [PII]. Date of birth will be [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And date of service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It will be [PII] with a billed amount of $299 even.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Is it right.
[AGENT][NEUTRAL] OK, it looks like we received that 2-18-2025. It was processed to [PII] and.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You said it's processed on to 20 right?
[AGENT][NEUTRAL] Yes, 220 and then it looks like this is not a covered service under the plan.
[AGENT][NEGATIVE] It was denied.
[CUSTOMER][NEUTRAL] You said that
[CUSTOMER][NEUTRAL] Mhm. It is not covered, right? Not covered under members uh provide this plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Sorry, which one did you say? Whether it is members or provider?
[AGENT][NEUTRAL] This is not a covered service under the plan.
[CUSTOMER][NEUTRAL] Yeah, that's the member's plan, right?
[AGENT][NEUTRAL] Yes, the member's plan.
[CUSTOMER][NEUTRAL] Mhm. OK. May I know what service that is not covered?
[AGENT][NEUTRAL] The service that it was billed for.
[CUSTOMER][NEUTRAL] You mean uh the office was it?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, just a moment, [PII].
[CUSTOMER][NEUTRAL] Thank you, [PII]. By the way, could you please send me a copy of your bill through fax?
[AGENT][NEUTRAL] What's your fax number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. Attention will be my name, [PII].
[CUSTOMER][NEUTRAL] By the way, may I know when did you receive the claim?
[AGENT][NEUTRAL] 2182025.
[CUSTOMER][NEUTRAL] It's uh [PII], mhm. Can I get the claim number?
[AGENT][NEUTRAL] 356-620-3
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Just to confirm claim was on [PII] and denied on [PII] and the claim was 356-6203 and it is not covered under this member's plan, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, we'll be receiving you between the end of the day, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the card will be a name and the status.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. I think that's all. Thank you for helping me. I hope you have a great day. Take care. Bye-bye.
[AGENT][POSITIVE] Thanks for calling APL. Have a great day too.