AccountId: 011433970860
ContactId: ffab5a22-9164-493d-b49b-b8d96f9070de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1437459 ms
Total Talk Time (AGENT): 288610 ms
Total Talk Time (CUSTOMER): 386780 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/ffab5a22-9164-493d-b49b-b8d96f9070de_20250331T18:01_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] My name is [PII]. I'm calling from provider office to check the claim status. Could you please help me with that, sir?
[AGENT][NEUTRAL] OK, sure, yes, I can assist you with claim status, Miss [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and you're calling from which facility for my notation? What's the name of the facility?
[CUSTOMER][NEUTRAL] Is a Florida West Side Hospital.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Miss?
[CUSTOMER][NEUTRAL] Policy number is 015710.
[CUSTOMER][NEUTRAL] 349
[CUSTOMER][NEUTRAL] M like Mary, L like Lima, 7.
[AGENT][NEUTRAL] OK, you gave me too many numbers. Can you repeat that one more time?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] 015
[CUSTOMER][NEUTRAL] 710
[CUSTOMER][NEUTRAL] 349
[CUSTOMER][NEUTRAL] M like Mary, L like Lima, 7.
[AGENT][NEGATIVE] You're giving me too many numbers. Do you have the copy of the card?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Wait a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I don't have it.
[AGENT][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] What's the spelling of the last name, [PII]?
[CUSTOMER][NEUTRAL] Number's last name is?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The first name is [PII]. It's [PII] is the initial. Date of birth, [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, let me see if I can find them with the name. OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] It's gonna be one more minute.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bla
[CUSTOMER][NEUTRAL] Yeah, when it comes.
[AGENT][NEUTRAL] OK, I found him. All right. And what is the date of service, Mr. [PII]?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, so it was [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK. And how much is the total charge?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] $11,483 even.
[AGENT][NEUTRAL] OK, let me see if I can find this claim. And again, that was [PII], correct?
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Then you open up.
[CUSTOMER][POSITIVE] If there is no problem.
[AGENT][NEUTRAL] All right. It looks like we're needing the explanation of benefits from the primary insurance to continue the processing of this claim. Looks like we received the claim twice and processed the claim twice. The last time that we received the claim was [PII]. We processed on [PII], and we still need the copy of the explanation and benefits from the primary insurance.
[CUSTOMER][NEUTRAL] OK. So for the confirmation, we have uh submitted it previously to the fax number that is [PII]. Is it the correct one?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So, you haven't received it yet?
[AGENT][NEGATIVE] We have not received the explanation on benefits. We received the claim again on February, but we have not received the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the claim number?
[AGENT][NEUTRAL] The claim number is 3,563,040.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK. So we should have to submit it to the same, the same fax number.
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Uh, could you please provide the reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Oh, could you please provide, uh, 3 more accounts for me?
[AGENT][NEUTRAL] Different members or the same member?
[CUSTOMER][NEUTRAL] Yes, different.
[AGENT][NEUTRAL] OK, let me make a note on this one before I move forward to the next one. OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Gonna be one more minute.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the next policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, the policy number?
[CUSTOMER][NEUTRAL] It is 02564245.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Name is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK. Um, and what is the date of birth?
[CUSTOMER][NEUTRAL] Date of birth, [PII].
[AGENT][NEUTRAL] OK. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] [PII]. Bill amount is $83,978.65.
[AGENT][NEUTRAL] Is this a range of date or one single day in [PII]?
[CUSTOMER][NEUTRAL] Only one single day.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Bear with me, let me pull this here in.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] Waiting on the system.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 8397479.
[AGENT][NEUTRAL] This was for the ER visit?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] This was for an ER visit?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I got a claim for 8340796, the amount?
[CUSTOMER][NEUTRAL] Wait a moment, I'll recheck it and verify it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, 834-07596. Is that right?
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Alright, so this one, let's see.
[AGENT][NEUTRAL] So based on the explanation of benefits from United Healthcare, there was nothing applied towards the deductible co-payment and co-insurance. If this is not correct, then we need an updated explanation of benefits.
[CUSTOMER][NEUTRAL] So denied for primary OB?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is the primary you'll be, primary is you had say?
[AGENT][NEUTRAL] The primary EOB we have here.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] doesn't show any amounts applied towards the deductible, co-payment or co-insurance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can we go to the next account?
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Is it the fax number? Could you please provide the fax number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's the same 1. [PII].
[CUSTOMER][NEUTRAL] OK. When was it received?
[AGENT][NEUTRAL] 18773659423.
[CUSTOMER][NEGATIVE] No, no, no, I received it.
[AGENT][NEUTRAL] 00, OK, give me just a second because I just left out to make my note. One moment.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] It was received [PII].
[CUSTOMER][NEUTRAL] [PII] and processed or denied?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Is the fax number is [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Is there any time you're calling?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you provide me one or two more accounts?
[CUSTOMER][NEUTRAL] Is it OK?
[AGENT][NEUTRAL] Yes, but I, I need to make a note on this one before I move forward. Uh uh do you need any information before I start my note again? Any other information you need?
[CUSTOMER][POSITIVE] OK, no worries.
[CUSTOMER][POSITIVE] OK, no worries. Take a note and uh let me know when you're ready.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] OK, what's the next one?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] 023
[CUSTOMER][NEUTRAL] 359
[CUSTOMER][NEUTRAL] 00 M like Mary, L like Lima, 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] What's the last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and what's the date of birth?
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Alright, what's the date of service and the amount of the claims?
[CUSTOMER][NEUTRAL] Date of service [PII] to the bill amount?
[CUSTOMER][NEUTRAL] $8,404 even.
[AGENT][NEUTRAL] OK, let me see if I can find this one.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] No, it's [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] OK, so on this one, we need the primary EOB to continue the processing of this claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is it the fact that we have previously submitted the mailing address is correct or not? It is [PII]. Is this the correct one?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] So, did you need to send it to the same mailing address or any other fax number?
[AGENT][NEUTRAL] The fax number that I provided uh previously is the same one. That address is also correct.
[CUSTOMER][NEUTRAL] OK. So, could you please provide the received and denied date?
[AGENT][NEUTRAL] It was received [PII], processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please provide me one more account?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yes, um, do you need any other information on this one so I can make my note, finalize the note.
[CUSTOMER][NEUTRAL] No, this one was uh clarified.
[AGENT][NEUTRAL] OK, be with me.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, what's the next one?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Let
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] It is 024.
[CUSTOMER][NEUTRAL] 62236 M. like Mary, L like Lima, number 8.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Member name is [PII] is the initial. Date of birth [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of claim?
[CUSTOMER][NEUTRAL] Date of service [PII] to the bill amount $14,740 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so for this one, we also need the explanation of benefits from the primary insurance to continue the processing of the claim.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We have sent it to the same fax number that I provided you previously. Is this the correct one?
[AGENT][NEGATIVE] It is the correct one. We have not received it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Received and the date, please.
[AGENT][NEUTRAL] Uh, the claim was received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you have any uh timely filing?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you. So thanks for your patience and have a nice day. Nice talking to you. Take care. Bye-bye.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Yes. Bye bye. Have a good day.