AccountId: 011433970860
ContactId: f75a8084-ec98-4618-955c-7ba1a4fffa60
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1551849 ms
Total Talk Time (AGENT): 358593 ms
Total Talk Time (CUSTOMER): 376995 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/f75a8084-ec98-4618-955c-7ba1a4fffa60_20250418T17:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII]. I'm calling from provider's office to check the medical claim status.
[AGENT][NEUTRAL] OK, [PII]. Hi, do you have the policy number?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, absolutely. The policy number is 02431041.
[AGENT][POSITIVE] OK, perfect. Thank you.
[AGENT][NEUTRAL] And then what's a good callback number in case our call gets dropped?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, my contact number is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And then patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] Yes, patient's name is [PII]. Date of birth on [PII] in the year of [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Sure. OK.
[AGENT][NEUTRAL] OK. And do you have?
[AGENT][NEUTRAL] And do you have the claim number on you?
[CUSTOMER][NEUTRAL] Yes, we have the claim number that is 3,541,480.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If you please spell your name, ma'am.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Sure, sir. OK. Got, got it, got it. And I'm asking now, so that's why I'm saying sorry.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah that is good.
[AGENT][NEUTRAL] OK, so it looks like the received date is [PII]. The process date.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] was [PII] as well.
[CUSTOMER][NEUTRAL] Same date.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh-huh. May I know the denied or paid or processed you that is.
[AGENT][NEUTRAL] Uh, what is the charge amount that you're asking for?
[CUSTOMER][NEUTRAL] On second
[CUSTOMER][NEUTRAL] The building amount is $72,205 even.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like we paid $500.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Toward this claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And I can give you that check number as well.
[CUSTOMER][NEUTRAL] Any patient responsibility for this one?
[AGENT][NEUTRAL] We do not determine patient's responsibility. You would have to ask them.
[CUSTOMER][NEUTRAL] OK, sure. May I know the pay information by check or AFT?
[AGENT][NEUTRAL] OK, so the check number is 201.
[AGENT][NEUTRAL] 853 1.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It was issued on?
[AGENT][NEUTRAL] And the check was issued on [PII].
[CUSTOMER][NEUTRAL] Mm. Clear date.
[AGENT][POSITIVE] It looks like this check is still outstanding for some reason. Um.
[CUSTOMER][POSITIVE] Still outstanding. OK.
[AGENT][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] OK. Uh for this one outstanding rate, it's almost complete one month. So, uh, if you don't mind, could you please, uh, cancel the check and reissue a new check, right?
[AGENT][POSITIVE] Yes, I can do that for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, just a moment. I'm gonna check um.
[AGENT][NEUTRAL] Our notes to see if anyone left.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] A note stating information about this hold on.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hi, are you there?
[CUSTOMER][NEUTRAL] Yeah, yes, yes. I'm here.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is it possible for to issue a check?
[AGENT][NEUTRAL] OK, just a minute. I'm trying to
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] See about this check really quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] So I will cancel this check and I'll reissue another one to be sent. I just wanna make sure that I have the correct address on file for provider's office.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Sure, I will say that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] PO Box.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] To the villain.
[AGENT][NEUTRAL] You said zip code is [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, just one moment, let me see if I need any additional information from you.
[AGENT][NEUTRAL] To reissue this check, OK?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it doesn't look like I need any additional information from you today for that check.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] If completed, uh, may I know the time?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so I can do that when we get off the phone. I'll send in that request.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then, do you have another policy you were wondering about?
[CUSTOMER][NEUTRAL] That means you're saying that uh any other claims?
[AGENT][POSITIVE] Yes. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] One second, I will check that here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Very.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, we have.
[CUSTOMER][NEUTRAL] But uh this is a different facility.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. What is the policy number?
[CUSTOMER][NEUTRAL] Yes, one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. OK. Yes, the policy number is 02497688.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what is the first and last name and date of birth?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes. Patient's name is [PII]. Date of birth on [PII], sorry, sorry.
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you're checking claim status for this one as well?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK. And do you have the claim number?
[CUSTOMER][NEUTRAL] Um, yes, we have a claim number that is 356-849-1.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So it looks like the received date was [PII]. The process date.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And this claim was denied.
[AGENT][NEUTRAL] Because the the services were rendered after after coverage was terminated, so.
[AGENT][NEUTRAL] This policy is lapsed, it is no longer active.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] May I know the members effective date and termination date?
[AGENT][NEUTRAL] Yes. So, the effective date was [PII], and then it looks like the term date was [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 1 2nd, 1 2nd.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] May I know the effective date, please. Uh sorry for that, asking that repeat again. Sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, no, you're OK. It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] From [PII], right?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Member have any other insurance?
[AGENT][NEUTRAL] Uh, let me double check for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. No other insurance.
[CUSTOMER][NEUTRAL] Sure, one second.
[CUSTOMER][NEUTRAL] Sure. Uh, I completed that, uh, check.
[AGENT][NEUTRAL] Sorry, what was that?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, you said that, uh, you will issue a new check, right? It was completed?
[AGENT][NEUTRAL] Oh, yes, I will issue a new check for that first uh policy that you gave me.
[CUSTOMER][NEUTRAL] Mhm. May I know the turnaround time for that one and may I know the call reference number for this book? Uh, if you're OK, could you please say that another claim also we have the phone and the another claim in my system.
[AGENT][NEUTRAL] OK, yes, I can check claim status for another one. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, one second. I will, I will verify here, one second.
[CUSTOMER][NEUTRAL] Uh, may I know the call reference number?
[AGENT][NEUTRAL] Yes, it is [PII], my first name, [PII], last initial and then today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh, sure, no problem. One second. I will prepare a note here in my system.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I put on time one week to issue a new check?
[AGENT][NEUTRAL] Um, I do not have the number for the, for the new check.
[AGENT][NEUTRAL] As of right now.
[CUSTOMER][NEUTRAL] Oh, no, no problem, but, uh, I will call back, right, after one week. Is she OK, sir?
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Yes, you can call back or I can call you.
[CUSTOMER][NEUTRAL] Uh-huh. OK, no problem.
[CUSTOMER][NEUTRAL] Mm, yes, we are going to get another claim here that is the last one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the policy number is for that one is the
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] One second, I'm checking.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Sure. One second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, the policy number 02462236.
[CUSTOMER][NEUTRAL] MLA
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] OK, and the patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hm. Patient's name is uh [PII].
[CUSTOMER][NEUTRAL] Uh, date of birth on [PII].
[AGENT][POSITIVE] OK, perfect. Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then do you have the claim number for that, that one?
[CUSTOMER][NEUTRAL] Yes, 3558928.
[CUSTOMER][NEUTRAL] Um
[AGENT][POSITIVE] Perfect, thank you.
[CUSTOMER][NEUTRAL] Welcome.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] like
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like this claim was denied because we are awaiting the EOB.
[CUSTOMER][NEUTRAL] We send up multiple times. Sorry. Could you please verify that one also?
[AGENT][NEUTRAL] Yes, let me go back and see if it's under a different claim number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK and the provider's office you're calling from?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Oh, sorry. It's uh from HCF Florida Kendal Hospital.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then how did you guys send in the document? Was it fax or mail?
[CUSTOMER][NEUTRAL] One second, I'm checking here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, through the fax number [PII].
[AGENT][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so I'm not seeing that you guys sent in another EOB.
[CUSTOMER][NEUTRAL] Uh, please be on hold. I'm checking here.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh, sure. Uh, may I know the fax number to submit the UOB?
[CUSTOMER][NEUTRAL] How
[AGENT][NEUTRAL] Yes, I can give you our claims address or fax number.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Let let me check somewhere else. Do you have the charge amount that you're looking for? It could be processed under a different claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, the bill amount is $14,740 even.
[AGENT][NEUTRAL] You said $40,740?
[CUSTOMER][NEUTRAL] of the patient.
[CUSTOMER][NEUTRAL] 14,000. It's $14,740 even.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] We found the claim number is correct, right? Um 3558928.
[CUSTOMER][NEUTRAL] You found only one time.
[AGENT][NEUTRAL] Yes, so I found that claim number, but I was looking to see if we processed it under a different claim, um, but it doesn't look like we received another EOB.
[CUSTOMER][NEUTRAL] Sure. May I know the fax number please submit the claim once again.
[AGENT][NEUTRAL] Yes, so the claim, uh, you want the fax number for us?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK. It is 877365.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] 3.
[CUSTOMER][POSITIVE] Sure. Thank you so much. Uh, thanks so much for giving me information. Uh, have a nice and happy weekend.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] Um, nothing, nothing else. Thank you so much for asking.
[CUSTOMER][NEUTRAL] And bye for now.
[AGENT][NEUTRAL] OK. And then, can, can you just give me the phone number to call you back?
[AGENT][NEUTRAL] For that check and just in case I have any more questions.
[CUSTOMER][NEUTRAL] Yes, my callback number is uh mhm.
[CUSTOMER][NEUTRAL] Uh-huh. Sure, sure. It's [PII]. It's a direct line, no extension.
[AGENT][NEUTRAL] No extension? OK, I just wanted to double check that callback number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] All right. Well, thank, yeah, thank you [PII] for calling APL and I will get this check processed and I hope you have a good weekend.
[CUSTOMER][NEUTRAL] Mhm. Sure. So.
[CUSTOMER][POSITIVE] Yeah, you too. Thank you so much and thank you.
[AGENT][POSITIVE] OK, thank you. Bye.