AccountId: 011433970860
ContactId: f8c362b6-75e9-4d68-a8fb-188689160d57
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 969460 ms
Total Talk Time (AGENT): 375002 ms
Total Talk Time (CUSTOMER): 245407 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/f8c362b6-75e9-4d68-a8fb-188689160d57_20250306T16:26_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] Um, good morning, [PII]. Um, my name is [PII]. I'm calling from Coral Gables Hospital.
[CUSTOMER][NEUTRAL] I'm calling to follow up on a claim, a medical bill.
[AGENT][NEUTRAL] OK, well, I can help you with the claim status, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And policy number I have 1255924 M as in Mary, L Lima number 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Um, [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] [PII].
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] $58,005.80.
[AGENT][NEUTRAL] OK, so this, I'm sorry, uh, [PII] $58,005.80.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So there is another policy, the policy number that you gave terminated on [PII].
[AGENT][NEUTRAL] Um, policy number 2295769 has been active since [PII]. I'm gonna check on that policy and see if there's a claim there because there wasn't one on this one.
[CUSTOMER][NEUTRAL] OK. And what was that number again? I'm sorry.
[AGENT][NEUTRAL] No, you're fine. 229-576-9.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome, and hold on one moment, [PII].
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Um, Coral Gables Hospital. It may say Stewart Coral Gables.
[AGENT][NEUTRAL] OK, it's included within this claim. OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, wait a minute.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] How many of them is it?
[AGENT][NEUTRAL] 12, is there one more?
[AGENT][POSITIVE] It must be this one.
[AGENT][NEUTRAL] Oh, I'm good. Y'all can't keep me down by 347-3536, and that maxed out.
[AGENT][NEUTRAL] The benefit watch.
[AGENT][NEUTRAL] But actually, let me put what it was on here.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] FAC.
[AGENT][NEUTRAL] 0580 OK so.
[AGENT][NEUTRAL] And 03536.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] That was the total bill. OK, [PII], you go girl.
[AGENT][NEGATIVE] Be sad, you know what you're doing.
[AGENT][NEUTRAL] OK, so what's this claim number 3473536. OK.
[AGENT][NEUTRAL] So let me get them all in a row.
[AGENT][NEUTRAL] So the first one.
[AGENT][NEUTRAL] And then this one.
[AGENT][NEUTRAL] And then this
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] To
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hello, [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] All right, thank you so much for holding. I apologize for that wait. So I had to do a little research, but I figured out what uh what's happening. So we received this claim 3 times. The original claim, um,
[CUSTOMER][NEUTRAL] It's fine.
[AGENT][NEUTRAL] was received back in [PII].
[AGENT][NEUTRAL] It was claim number 3473536.
[AGENT][NEUTRAL] And we paid to this total $3500.
[AGENT][NEUTRAL] So when the other two claims came in, they were denied um because it was already paid out on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, let me ask you, do you see that that that payment actually went out because we don't have it.
[AGENT][NEUTRAL] I can check on it. Hold on one second, let's see.
[AGENT][NEUTRAL] OK, so I'm showing that it was a single check, um, check number 1859363.
[AGENT][NEUTRAL] Uh, it was mailed to [PII]. Is that the correct address?
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Do.
[CUSTOMER][NEUTRAL] Just pulling up the.
[CUSTOMER][NEUTRAL] Addresses.
[CUSTOMER][NEUTRAL] All right. Now, I see that that's the physical address. I don't believe that's where um checks go. So you shouldn't, you shouldn't see on your system that it was cashed.
[CUSTOMER][NEUTRAL] Are you able to tell?
[AGENT][POSITIVE] Right, right, I'm showing that it's outstanding. That's why I'm asking if that's the correct address. So, yes, it is still showing as outstanding.
[CUSTOMER][NEUTRAL] Yeah, that's the, that's the physical. I see that there's a, there's a PO box.
[CUSTOMER][NEUTRAL] For um the pay to address.
[AGENT][NEUTRAL] OK, so hold on one moment because I believe for that now corrected claim is gonna have to be submitted with the correct address because this is the address that's on the claim.
[CUSTOMER][NEUTRAL] Now both addresses are on the claim if you pull up the, the claim image.
[CUSTOMER][NEUTRAL] There's uh the address where service was rendered and then there's the, the address um I, I'm not sure what what it's titled on the on the claim image.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Let me see if I can pull it up this way. Hold on one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Um, I first want to make sure.
[AGENT][NEUTRAL] Where the claim must be submitted. OK, so yep, I was right. Whoop whoop.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Let me see if I can pull it up like this because for some reason on base and.
[AGENT][NEUTRAL] I are not talking right now.
[AGENT][NEUTRAL] W[PII] was this process?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'll do this one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Alright, thank you so much for holding. So I do see what you're saying with the 3100 is and then on box two is the PO box. So it's supposed to be going to the PO box.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so let me reach out to claims and see if a corrected claims um needs to be received or if they can use this and reissue um so give me just a few more moments I'm gonna call them on the other line, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[AGENT][NEGATIVE] This is gonna be so hard.
[CUSTOMER][NEUTRAL] F
[AGENT][NEUTRAL] You know what, hold on, cause I'm not supposed to, I don't, am I? I don't remember.
[AGENT][NEUTRAL] I don't remember.
[AGENT][NEUTRAL] I, I have to figure it out after this call. It is what it is. I don't remember.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] on the care team. How are you doing?
[CUSTOMER][POSITIVE] Pretty good how are you?
[AGENT][NEUTRAL] I'm doing good. Can you look at a um claim form with me? I have a provider on the other line. We, there's two addresses on the claim form, we sent it to one versus the other and
[AGENT][POSITIVE] The checks outstanding.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Certainly. What is the policy number?
[AGENT][NEUTRAL] It is 229-576-9.
[CUSTOMER][NEUTRAL] OK, thank you. And the insured name and date of birth. Uh what am I saying? Uh, which, OK, the insured, oh my gosh, OK, which claim is it?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] It's um the 3473536, [PII].
[CUSTOMER][NEUTRAL] OK, it's when uh uh Coral Gables Hospital. Does that sound right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and they're wanting to know why we send it to the place that we did, right? Is that?
[AGENT][NEUTRAL] Right, so I was, so at first I said um I told him to submit a corrected claim because of the address, and then he said, well, both addresses are on the claim form, so then I pulled the claim form on base and it is, so I don't know, should I, do they still need to correct the claim or can we use this to reissue? I didn't know how that works.
[CUSTOMER][NEUTRAL] Uh, well, let's see what we have here waiting for this to come up.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK. All right. I see what happened. So what normally would happen is um
[CUSTOMER][NEUTRAL] [PII] is where the, the, uh, I don't know, the service has actually happened I guess it's the best way to put it and [PII] is where the it's where it should have gone so um they don't need a corrected one so much as the uh I'm thinking what we need to do it OK.
[AGENT][NEUTRAL] Mhm, like
[AGENT][NEUTRAL] Should I just send the hub to [PII] to reissue?
[CUSTOMER][NEUTRAL] Yes, I think that's exactly what needs to happen, um, and then what we do is we'd have to, we're gonna have to, uh, send it to the the second address, the one in [PII], and if we could get that one, then would be good, but yeah, that's, that's what's happened. It's just that you know that we do have two addresses, um, on the, uh, on the, on the VIN, uh, uh, screen, but it should have gone to the one in, in [PII] rather than that, yeah, so yeah that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So yeah, just the have request.
[AGENT][POSITIVE] Alrighty, well, thank you very much.
[CUSTOMER][POSITIVE] You bet. Thanks. Have a good day.
[AGENT][POSITIVE] All right you too.
[AGENT][NEUTRAL] OK, hello, [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] All right, thanks for holding. So, um,
[AGENT][NEUTRAL] Since both addresses are on the claim form, um, there was an error, so [PII], like you said, is for where it should have gone. So I'm gonna send this back to um [PII], who handles our checks for her to reissue to the [PII].
[CUSTOMER][NEUTRAL] OK, um, and you said her name is [PII]. OK, let me just make sure that I have the, the check details so I could just put that in my notes so they know what to expect, um.
[CUSTOMER][NEUTRAL] Uh, the check number was 1859363.
[AGENT][POSITIVE] 1859363. Yep, that's correct.
[CUSTOMER][NEUTRAL] OK, and what was the amount of that check?
[AGENT][NEUTRAL] $3500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, and what was your name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Thank you and uh is there a um a turnaround time?
[AGENT][NEUTRAL] Um, so we usually say 7 to 10 business days, um, just for like our standard turnaround time because this is a reissue, it could be less than that, but we just give that just in case.
[CUSTOMER][NEUTRAL] OK, and is there a reference number for this call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date.
[CUSTOMER][POSITIVE] OK great thank you so much.
[AGENT][POSITIVE] You're very welcome. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] That is it. You've been very helpful. Have a great day.
[AGENT][POSITIVE] All right. You're welcome. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.