AccountId: 011433970860
ContactId: 08c1ddd0-6969-4f69-abe5-596f4a577ca7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 238350 ms
Total Talk Time (AGENT): 112230 ms
Total Talk Time (CUSTOMER): 79311 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/08c1ddd0-6969-4f69-abe5-596f4a577ca7_20250319T15:41_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm [PII] calling from provider's office.
[AGENT][POSITIVE] Good morning, [PII]. How are you doing today?
[CUSTOMER][POSITIVE] Thanks for asking, [PII]. I'm great. What about you?
[AGENT][POSITIVE] I'm doing well, thank you, [PII] and what is a good callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, [PII] and what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] That would be 01940423.
[AGENT][NEUTRAL] And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] The member's name would be [PII] and the date of birth would be [PII].
[AGENT][POSITIVE] Thank you, [PII]. I do have the policy pulled up. How can I help you today?
[CUSTOMER][NEUTRAL] I just want to know the denial status of the claim.
[AGENT][POSITIVE] It would be my pleasure to assist you. Do you have that claim number or date of service?
[CUSTOMER][NEUTRAL] Mm, I do have a claim number. Just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 356-2282.
[AGENT][NEUTRAL] And what is the facility name?
[CUSTOMER][NEUTRAL] That would be Advent Health Palm Coast.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Now [PII], I'm showing that we received that claim on [PII] and processed on [PII]. This claim was denied because the max benefit has been met for that occurrence.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. May I know uh whether it's exhausted in terms of dollars or units?
[AGENT][NEUTRAL] It's going to be a dollar amount per occurrence.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Actually, what was the actual amount and how much we exceed?
[AGENT][NEUTRAL] The benefit amount is $250 per occurrence. Now that is a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK. Uh, so we have exceeded $250 right?
[AGENT][POSITIVE] That's correct. He's maxed out his benefits for that occurrence.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, was it under this, uh, claim or it was combined with other claim?
[AGENT][NEUTRAL] It was with under another claim for the same data service.
[CUSTOMER][NEUTRAL] OK. May I have that claim number?
[AGENT][NEGATIVE] I'm unable to disclose that information. It was with a different provider.
[CUSTOMER][NEUTRAL] Uh, it's with a different provider.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Uh, at least, can I know the account number?
[AGENT][NEUTRAL] On your claim?
[AGENT][NEUTRAL] I can give you
[CUSTOMER][NEUTRAL] No, uh, for the claim, uh, that was combined with.
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] I'm not able to disclose that information.
[CUSTOMER][NEUTRAL] Uh, but, uh, there should be some proof that for us to validate, right?
[AGENT][NEUTRAL] Let me check something real quick. AdventHealth, Palm Coast.
[AGENT][NEUTRAL] AdventHealth. I'm checking the um
[AGENT][NEUTRAL] Tax ID number.
[AGENT][NEUTRAL] Yeah, it was a different tax ID number so I can't disclose any information on that.
[AGENT][NEUTRAL] Other claim
[AGENT][NEUTRAL] That was paid
[CUSTOMER][NEUTRAL] OK, just, may I know the call reference number?
[AGENT][NEUTRAL] It's going to be my name and today's date, and I spell my name [PII].
[CUSTOMER][POSITIVE] Alright, thank you so much, [PII]. Have a great day. Bye-bye.
[AGENT][POSITIVE] It's been a pleasure to assist you with that uh claim status. Anything else I can help you with before you go?
[CUSTOMER][POSITIVE] No, that's all for today. Thank you.
[AGENT][POSITIVE] And thank you for calling APL. I thank you. Have a wonderful day.