AccountId: 011433970860
ContactId: 33acfe46-794c-4938-ab69-e690209069fe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 310559 ms
Total Talk Time (AGENT): 96251 ms
Total Talk Time (CUSTOMER): 85780 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/33acfe46-794c-4938-ab69-e690209069fe_20250327T16:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, sorry, what's your name?
[AGENT][POSITIVE] My name is [PII], that's [PII].
[CUSTOMER][NEUTRAL] Hello, [PII]. This is [PII]. I'm calling from the office. And how are you doing today?
[AGENT][POSITIVE] I'm good. How about you, Mister [PII]?
[CUSTOMER][NEUTRAL] I'm, I'm doing pretty well, ma'am. Thank you for asking. Uh, so actually I have a claim here and, um, yeah, which is partially paid. So I want to talk about that. Can you help in the claim?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Sure, I can assist you with claims Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. It'll be [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm, OK, and may I have the facility you're calling from?
[AGENT][NEUTRAL] The name?
[CUSTOMER][NEUTRAL] AdventHealth, yeah, sir. AdventHealth respiratory and Equipment.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Policy number is 02496908.
[AGENT][NEUTRAL] OK. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth of the patient is [PII].
[AGENT][NEUTRAL] Um, thank you, Mr. [PII]. And what is the date of service and the amount of the claim or the claim number if you have it?
[CUSTOMER][NEUTRAL] I have the claim number. It's uh 356 8.
[CUSTOMER][NEUTRAL] 733.
[AGENT][NEUTRAL] OK, thank you. One moment, let me pull a copy of that EOB, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm still waiting in front of EOB. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I have it pulled up. All right, and you said it was partially paid. There is a claim or a procedure that was denied. um.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah. 87038.
[AGENT][NEGATIVE] And that's procedure. Yes, that is denied because it, it doesn't meet the definition of doable medical equipment under our contract.
[CUSTOMER][NEUTRAL] Um, sorry, what did you say?
[AGENT][NEGATIVE] It doesn't meet the definition of medical doable equipment under our policy contracts.
[CUSTOMER][NEUTRAL] Mm, like how it's a doable equipment 87038.
[AGENT][NEUTRAL] We do not cover anything that is disposable. We don't cover disposable supplies. So that one is a disposable supply it's not covered under the policy.
[CUSTOMER][NEUTRAL] It's a filter.
[CUSTOMER][NEUTRAL] OK, let me mention it.
[CUSTOMER][NEUTRAL] plan.
[CUSTOMER][NEUTRAL] OK, got it. May I have the claim receiving date for this?
[AGENT][NEUTRAL] OK, sure, bear with me just a second.
[AGENT][NEUTRAL] OK, so the received date was [PII], processed [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII] got it.
[CUSTOMER][NEUTRAL] So the, so it's a member responsibility, the amount or like what it's a provide loss.
[AGENT][NEUTRAL] It's up to it's up to the provider's discretion. We don't have any contractual involvement on the remaining of the claim, so it's up to the provider's discretion.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK. Got it. Finally, may I have the call reference for this?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you would like.
[CUSTOMER][POSITIVE] OK. I'll do that. Thank you much for all your help. Have a good day.
[AGENT][POSITIVE] You as well, and thank you for calling APO. Have a good day, Mr. [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You too. Bye-bye.