AccountId: 011433970860
ContactId: 0980346d-76d6-451e-a4b7-969b430c64ef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 427980 ms
Total Talk Time (AGENT): 159898 ms
Total Talk Time (CUSTOMER): 147463 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/0980346d-76d6-451e-a4b7-969b430c64ef_20250425T18:02_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] A very good afternoon. My name is [PII] and my last initial is [PII]. I'm calling from Advent Health in regards to claims.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] OK, sure. I can assist you with things. And may I have a callback number just in case we get disconnect, Miss [PII]?
[CUSTOMER][NEUTRAL] Definitely. It is [PII].
[AGENT][NEUTRAL] Thank you and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that would be 02.
[CUSTOMER][NEUTRAL] 20
[CUSTOMER][NEUTRAL] 03
[CUSTOMER][NEUTRAL] 942
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, 7.
[AGENT][NEUTRAL] OK, that was too many numbers. Um, do you wanna check the card and see um if you have a card because it's too many numbers.
[CUSTOMER][NEUTRAL] OK. Um, seems like we don't have one.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and let me have that number one more time. Let me see if I can figure it out.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, is it possible for you to check with the
[CUSTOMER][NEUTRAL] Social Security?
[AGENT][NEUTRAL] Mhm, yes, let me go ahead and pull that system, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] So it is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the name of the patient?
[CUSTOMER][NEUTRAL] OK. The first name is [PII], the last name is [PII]. The date of birth is on [PII].
[AGENT][NEUTRAL] What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] This is for [PII] for the amount of $44.12.
[AGENT][NEUTRAL] That's $44.12 or $45.12.
[CUSTOMER][NEUTRAL] Um $44.20.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me see if I can find this claim. For future, you can check claim status online through our website at [PII] and that's just optional. And bear with me, let me pull this EOB, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] If.
[AGENT][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Good morning one you send one.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] You're waiting on the system, OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] that.
[AGENT][NEUTRAL] It looks like we processed the claim on [PII] and the claim was denied. Um, the reason for this denial is that we have received the primary explanation of benefit that was submitted with the claim. However, the explanation of benefits received does not apply any amount towards the deductible co-payment or co-insurance.
[CUSTOMER][NEUTRAL] Um, maybe we have sent you the wrong information, I guess, but there is a deductible applied towards the patient's responsibility. That's OK. Uh, is it OK that if we send the primary COP again?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, you can go ahead and send the copy of the primary again.
[CUSTOMER][NEUTRAL] OK. Um, may I know, can I have the
[AGENT][NEUTRAL] Do you wanna fax it or mail it?
[CUSTOMER][NEUTRAL] Um, mail it.
[AGENT][NEUTRAL] OK. The address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, just to confirm, [PII], [PII]. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment. Uh, can I have the attention too?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claims department.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Claims department, perfect.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um,
[CUSTOMER][NEUTRAL] Oh yeah. Can I have the denied date?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Um, the date, the denial of the claim or the process of the claim is the same date, which is [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] And um [PII]. Can I have the claim number?
[AGENT][NEUTRAL] Yes, 358-755-55.
[CUSTOMER][NEUTRAL] 7555. OK, perfect. And can, uh, is there any attention, I mean, is there any timely finding to submit the primary UB?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] No, we don't have time to sign for you to submit a document or a claim.
[CUSTOMER][NEUTRAL] OK. Can I have your name spelled, please?
[AGENT][NEUTRAL] Sorry, that's [PII]. That's initial [PII].
[CUSTOMER][NEUTRAL] Thank you sir and can I get the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers, you can use my name in today's date if you will.
[CUSTOMER][POSITIVE] OK. Thank you so much. Have a great day ahead. So bye-bye.
[AGENT][POSITIVE] You as well thank you for calling ATL. Bye-bye, Miss [PII].
[CUSTOMER][NEUTRAL] Yeah