AccountId: 011433970860
ContactId: f87f0974-0b90-4a16-b118-b8f5d8801cca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 453220 ms
Total Talk Time (AGENT): 160821 ms
Total Talk Time (CUSTOMER): 153935 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/f87f0974-0b90-4a16-b118-b8f5d8801cca_20250401T19:38_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], hi, um, I just had a question. Um, I'm receiving a bill um from University of Miami, and I just wanted to know if, you know, if the bill actually went to you afterwards, you know, to my secondary or if it even goes there. I just wanted to know if, you know.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If I needed to pay this or if my secretary would cover something.
[AGENT][NEUTRAL] OK, what was your name?
[CUSTOMER][NEUTRAL] OK, my name is [PII].
[AGENT][NEUTRAL] And do you have your policy number, [PII]?
[CUSTOMER][NEUTRAL] My number is
[CUSTOMER][NEUTRAL] Benefit certification number? He had a, he, he had a surgery at a hospital, OK, this is for my son. He
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. I'll just give you the, the hos the outpatient because it was done outpatient. 02212315 ML 8.
[AGENT][NEUTRAL] And your son's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And then just need a few pieces of information from you. What is your birth date?
[CUSTOMER][NEUTRAL] Mine is [PII].
[AGENT][NEUTRAL] And your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your email address?
[CUSTOMER][NEUTRAL] [PII] oh well actually this is from work, so it would be [PII].
[AGENT][NEUTRAL] OK, thank you. And then just in case we get disconnected, what's your telephone number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and what was that date of service for your son?
[CUSTOMER][NEUTRAL] Well, [PII].
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] That was [PII], correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Do you know what the total bill charges were for that?
[CUSTOMER][NEUTRAL] OK, so it says here, um,
[CUSTOMER][NEUTRAL] It says here charges were 4,095.
[CUSTOMER][NEUTRAL] And then it says that my insurance paid 2, I'm sorry, 2,775, and that my responsibility is 1,319.
[AGENT][NEUTRAL] Let's see here.
[CUSTOMER][NEUTRAL] I have a name. It says it's from the University of Miami, but it says I have a doctor's name, provider name.
[AGENT][NEUTRAL] What type of services were they?
[CUSTOMER][NEUTRAL] It says here anesthesia, neuro anesthetic, I guess.
[AGENT][NEUTRAL] OK, let's see
[AGENT][NEUTRAL] OK, you said 12:11, right?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we've got the facility claim but we don't have the primary explanation of benefits.
[AGENT][NEUTRAL] So it looks like that's that's what we're waiting on.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What do you mean primary bene what is that you need? I'm sorry. What do you mean the explanation of benefits is what I mean.
[AGENT][NEUTRAL] So, do you have other insurance?
[CUSTOMER][NEUTRAL] United Healthcare.
[AGENT][NEUTRAL] OK, that's what we're waiting on. We don't have the EOB from United Healthcare.
[AGENT][NEUTRAL] What what I have on file, I've got 22 claims, same dollar amount, and this looks like for the facility.
[AGENT][NEUTRAL] So, University of Miami.
[AGENT][NEUTRAL] I don't have any doctors claims or anything. This is just for the
[AGENT][NEUTRAL] Inpatient charges for the facility.
[CUSTOMER][NEUTRAL] Is it that amount is?
[AGENT][NEUTRAL] Uh, the amount
[CUSTOMER][NEUTRAL] Is it that amount?
[AGENT][NEUTRAL] Now is $12,792.
[CUSTOMER][NEUTRAL] Oh, OK, so it's not the, so you don't have anything for.
[CUSTOMER][NEUTRAL] Either 4,0095 or 1319.
[AGENT][NEUTRAL] No, I don't.
[AGENT][NEUTRAL] No, I don't have that. I just have.
[CUSTOMER][NEGATIVE] You wouldn't get
[AGENT][NEUTRAL] Go, go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Would you get something like that? Would you guys get something from anesthesia?
[AGENT][NEUTRAL] It just depends on if they if they have your card at the time of service and then they need to submit the claim to us um so looks like, like I said the only thing I have on file right now is is the looks like the facility fee like the hospital charges.
[AGENT][NEGATIVE] Like the total for that bill, and we've denied it because we need the United Healthcare explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's all we have so far.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But you pay anyways a certain amount of money.
[CUSTOMER][NEUTRAL] Per day, correct?
[AGENT][NEUTRAL] Um, for your policy, let me look and see what we got.
[AGENT][NEUTRAL] Um, and this is not a guarantee of payment, it's just a basic outline of your policy. So for your policy, it looks like.
[AGENT][NEUTRAL] I'm pulling up to see what your benefit is. Give me just one moment.
[AGENT][NEUTRAL] So for inpatient services it's $3000 per covered person per year and then outpatient.
[AGENT][NEUTRAL] It's $500 per covered person per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] So they really need to file the claims with us, um, along with that explanation from United Healthcare, and then we can process according to your policy.
[CUSTOMER][NEUTRAL] OK, so I should just call this provider?
[AGENT][NEUTRAL] Yes, I would give that provider a call and let them know that we don't have a claim on file if they can file with us and then um then we can get that processed.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][POSITIVE] OK. All right, thank you.
[AGENT][POSITIVE] OK, thanks for calling ATO. Have a good day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank, thank you very much. You too, bye.
[AGENT][NEUTRAL] All right.