AccountId: 011433970860
ContactId: f91a6b28-70e8-4460-99f3-03e84961a5da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 714340 ms
Total Talk Time (AGENT): 159574 ms
Total Talk Time (CUSTOMER): 161442 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/f91a6b28-70e8-4460-99f3-03e84961a5da_20250414T16:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Sorry, your line cut it off. What's your name again? I'm sorry.
[AGENT][NEUTRAL] My name is [PII]. I'm with APL. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII]. First initial, my surname is [PII] calling from the business office from Brownsville Hospital. I'm just calling today to follow up for an upheld denial letter.
[AGENT][NEUTRAL] OK, I can help you with the claim. Um, Ms. [PII], can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. It's um [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then, um, and you said you were calling from Brownsville Hospital, is that correct?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] The patient's name is [PII]. The date of birth is [PII]. Member ID is ZGP840007075.
[AGENT][NEUTRAL] OK, do you see another member ID number? That is not one of our policy numbers.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm sorry, um 01868783.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, and then what is the date of service for Norma and the charge amount?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Today's service is [PII] with a total charge of $99,0071 even.
[AGENT][NEUTRAL] OK, and then what's the charges after the primary insurance pay their part?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Let me check on that.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Do
[CUSTOMER][NEUTRAL] That was the only charge um I see it here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] And you said the claim has already been denied. Can you give me the claim number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure. It's 355-084-9.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, Ms. [PII], while I look this claim up and I will be right back, ma'am.
[CUSTOMER][POSITIVE] OK, sure, thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you very much, Ms. [PII], for holding for me. I do show that the claim was paid with check number [PII] in the amount of $2550.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, once that payment was made, it exhausted the benefits for the calendar year.
[AGENT][NEUTRAL] And the check has cleared the bank on December, I'm sorry, [PII].
[AGENT][NEUTRAL] Are you there?
[CUSTOMER][POSITIVE] Yes I am. I'm sorry.
[AGENT][NEUTRAL] Yes, did you get the information?
[CUSTOMER][NEUTRAL] Yeah, what's um what's about the bank?
[AGENT][NEUTRAL] No, the, the claim was paid $2550. Once that $2550 was paid, it exhausted the benefits for the calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was paid with check number 2022598.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the check cleared the bank on [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh yeah, sorry, um.
[CUSTOMER][NEUTRAL] But after that, um, [PII] we sent an appeal on um.
[CUSTOMER][NEUTRAL] [PII] and it was upheld on [PII].
[AGENT][NEUTRAL] OK, let me look.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, I do not find any information about the appeal.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, I do know that once.
[CUSTOMER][NEUTRAL] You say I'm sorry um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, um, we already received that amount you have.
[CUSTOMER][NEUTRAL] Just said, however, um, we are needing the copy of the denial letter for us to proceed um for the next letter of this claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, can you please give me your fax number and I will send that to you.
[CUSTOMER][NEUTRAL] OK, thank you for that, I'm sorry. The fax number is [PII].
[AGENT][NEUTRAL] OK, and then you spell your name [PII]
[CUSTOMER][NEUTRAL] And um please put the attention, no um put the attention to um Valley Baptist Brownsville Hospital.
[CUSTOMER][NEUTRAL] With the patient number 09173-310.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I get that fax ready for you, Ms. [PII], and I'll be right back.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I have that fax on its way to you now.
[CUSTOMER][NEUTRAL] Well thank you for that sorry. One last thing, can I have a call reference number?
[AGENT][NEUTRAL] Yes, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Uh thank you for that. That was all for me. Thank you for assisting me today. Have a great day ahead. Bye bye for now.
[AGENT][POSITIVE] You too. You too. You have a wonderful day and thank you for calling APL Ms. [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] OK.