AccountId: 011433970860
ContactId: 0f39e4a9-5fca-47a0-be70-477c30fa2e89
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 649479 ms
Total Talk Time (AGENT): 166213 ms
Total Talk Time (CUSTOMER): 163092 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/0f39e4a9-5fca-47a0-be70-477c30fa2e89_20250429T16:09_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APTO. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. This is [PII] calling from AdventHealth. And uh sorry, I didn't catch your name pretty well. Can you spell that for me?
[AGENT][NEUTRAL] Sure, that's [PII]. And you said your name is [PII]?
[CUSTOMER][NEUTRAL] yeah.
[CUSTOMER][NEUTRAL] No, it's [PII] spelled as [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have a callback number just in case we get disconnected, Mr. [PII].
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, patient's policy number is 02483142.
[AGENT][NEUTRAL] What is the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Mhm. I'll provide you with that.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] My name is [PII] and the date of birth is [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right, so you say you need a claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What is the service.
[CUSTOMER][NEUTRAL] Uh, yeah, the date of service is [PII].
[AGENT][NEUTRAL] All right. And how much is the total charge on the claim?
[CUSTOMER][NEUTRAL] It's $30,473.93.
[AGENT][NEUTRAL] OK, thank you. Let me see if I can find this claim and for future, you can check claim status online through our website at [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's see. OK, let me pull this ELB. It's gonna be a few minutes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I don't
[AGENT][NEUTRAL] Mm. Yes, I'm waiting on the system. I'm waiting on the EUV.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, no problem.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] All right, so it looks like we processed the claim on [PII] and we send a benefit amount of $500 which that is the maximum payable for data for date of service.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Oh, OK, just give me a moment. So you process the claim on [PII], right? So may I have the claim number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, that's 357-838-1.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So we do expect for this particular claim.
[CUSTOMER][NEUTRAL] Yeah, we expect $3,999.67. The claim was underpaid. Can you send this claim for review or the process?
[AGENT][NEUTRAL] Um, no, Mr. And, so this claim was processed correctly based on the benefits of the policy. With the payment of the check, the maximum benefit payable for the date of service has been met. 500 is the maximum benefit per day.
[CUSTOMER][NEUTRAL] And can you
[CUSTOMER][NEUTRAL] OK, got it. But, uh, so, yeah, what was the bill amount on your claim?
[AGENT][NEUTRAL] OK, we go by the benefit, Mr. And so, the policy benefit is $500 per day, even though the charge or the amount that was supplied was $3,252.19 the maximum benefit of the policy is $500 per day.
[CUSTOMER][NEUTRAL] OK, so can we bill the uh remaining balance to the member or a patient?
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't, we cannot tell you what to do with the remaining.
[CUSTOMER][NEUTRAL] OK, got it. So as per member's policy, the uh maximum allowed per day is $500 right?
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Correct, yes, that is correct.
[CUSTOMER][NEUTRAL] OK. Uh, OK. Can you please fax us the EOB copy stating the same? Uh, is there any specific line mentioned on the UOB stating the same?
[AGENT][NEUTRAL] Um, yes, uh, on the remarks code in the back of the EOB indicates with this check the maximum payable for this state of service has been met.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] So it is indicated on the ELB.
[CUSTOMER][NEUTRAL] OK, got it. It's, that's enough.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, yeah, that's enough for me. So, can you please fax the which you are looking at?
[AGENT][NEUTRAL] Sure, what is the fax number?
[CUSTOMER][NEUTRAL] Yeah, sure. Yeah, I'll give you that. Uh, give me a moment. Yeah, the fax number is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] And uh send it to attention with my name and so.
[AGENT][NEUTRAL] And so, OK, sure, no problem. One moment, let me go ahead and send it right now, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me Mr. And so yeah, I'm gonna ahead and send that over to you. It should be there in a few minutes. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, can I have the card 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, got it. Thank you for assisting with this one. Have a great day and bye-bye for now.
[AGENT][POSITIVE] You as well. Thank you for calling APO. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm.