AccountId: 011433970860
ContactId: f198c5b0-2d14-42ca-b4fb-bd51837704f3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 720000 ms
Total Talk Time (AGENT): 167573 ms
Total Talk Time (CUSTOMER): 114127 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/f198c5b0-2d14-42ca-b4fb-bd51837704f3_20250512T14:16_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] My name is [PII]. [PII] is spelled [PII]. I'm calling from Florida Hospital Medical Group for claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status. And may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] It's [PII], no extension.
[CUSTOMER][NEUTRAL] The patient's ID it's [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII], [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] The date of service is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], the bill amount is $801.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And you said $801?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Here we go.
[AGENT][NEUTRAL] And the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Shrida Regoli.
[AGENT][NEUTRAL] The facility name?
[CUSTOMER][NEUTRAL] facility is Florida Hospital Medical Group.
[AGENT][NEUTRAL] And I'm trying to received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 6374.
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because the inpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I still do have for the same member but different data service.
[AGENT][NEUTRAL] OK, what's the other dates of service?
[CUSTOMER][NEUTRAL] [PII]. build amount is $640.
[AGENT][NEUTRAL] 640.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, do you have any other dates of service?
[CUSTOMER][NEUTRAL] Yes, I do. I have
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. The amount is $847.
[CUSTOMER][NEUTRAL] I have [PII]. Billed amount is $320 and I have the last 1 [PII]. The billed amount is $438.
[AGENT][NEUTRAL] 458458.
[CUSTOMER][NEUTRAL] 438.
[AGENT][NEUTRAL] 03, OK, hold on one second.
[AGENT][NEUTRAL] Alright, do you mind if I place you on just a brief hold while I get the status for these claims for you?
[CUSTOMER][NEUTRAL] Mm this girl.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so you already did that one.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, A.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hey, thank you so much for holding. I apologize for that wait. So the first um date of service for [PII], um, we received that claim on [PII].
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 636-1.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the inpatient um max for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The next
[CUSTOMER][NEUTRAL] To the next one.
[AGENT][NEUTRAL] Mhm. The next one is [PII], same day, [PII] it was received. [PII], it was um processed.
[AGENT][NEUTRAL] Claim number is 358.
[AGENT][NEUTRAL] 636-4.
[AGENT][NEGATIVE] And denied because the inpatient max was used for the calendar year.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Next day, [PII].
[AGENT][NEUTRAL] Received on [PII].
[AGENT][NEUTRAL] Claim number is 35843558.
[AGENT][NEUTRAL] And on [PII], the claim was denied because inpatient Max was used for the year.
[AGENT][NEUTRAL] And last 1 [PII]. We also received this on [PII].
[AGENT][NEUTRAL] Claim number is 35843662.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the inpatient um benefit has been used for the year.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] May I have your name again? I think I catch it and the reference number.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, so there's no call reference number, but you can use my name in today's date and that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you very much, [PII]. That'll be all for me.
[AGENT][POSITIVE] You're very welcome. Well, thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Too bye bye.
[AGENT][POSITIVE] Thank you bye bye.