AccountId: 011433970860
ContactId: 346c8eae-6af5-430f-9373-5a3caa93889c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 361170 ms
Total Talk Time (AGENT): 153328 ms
Total Talk Time (CUSTOMER): 130260 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/346c8eae-6af5-430f-9373-5a3caa93889c_20250212T14:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh hello, this is A [PII]. I'm calling from AdventHealth. Uh, I do have a claim with me. I just wanna check on the claim status.
[AGENT][NEUTRAL] You're needing to check claim status, is that correct?
[CUSTOMER][NEUTRAL] Yeah. Yes.
[AGENT][POSITIVE] Yes, I can help you with that and could you spell your name for me please?
[CUSTOMER][NEUTRAL] Yeah. That is [PII] [PII]. Can you spell the name, please?
[AGENT][POSITIVE] Thank
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And [PII], what is your call? You're welcome. What is your callback number?
[CUSTOMER][POSITIVE] OK. Thank you for that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's [PII]. It's a direct line.
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you. And the member's policy number, Ash?
[CUSTOMER][NEUTRAL] Uh, member's policy number is 02359498 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] The patient's name is [PII]. Her date of birth is [PII].
[AGENT][NEUTRAL] I'm sorry, what is the person's name?
[CUSTOMER][NEUTRAL] Uh, the first name is [PII], the last name is [PII]. Can you spell it out if you want.
[AGENT][NEUTRAL] Uh, yes, spell the last name.
[CUSTOMER][NEUTRAL] Last name is [PII].
[AGENT][POSITIVE] [PII] OK alright thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the date of service and total bill amount please?
[CUSTOMER][NEUTRAL] Uh, the date of service is [PII] with the total charge amount of $2,851 even.
[AGENT][NEUTRAL] OK, 28, what is the amount again?
[CUSTOMER][NEUTRAL] 2851 even.
[AGENT][NEUTRAL] Thank you and your claim number?
[CUSTOMER][NEUTRAL] I don't have a claim number.
[AGENT][NEUTRAL] Oh, you, I thought you said you had a claim. OK, just a moment.
[CUSTOMER][NEUTRAL] It's recently built on.
[CUSTOMER][NEUTRAL] No, yeah, yeah.
[AGENT][NEUTRAL] OK, and you said the data service is 44 to 413, is that correct?
[CUSTOMER][NEUTRAL] 44 4:30. That is 30.
[AGENT][NEUTRAL] OK, let's start again.
[AGENT][NEUTRAL] What is the what is the date of service?
[CUSTOMER][NEUTRAL] The data of service is [PII].
[CUSTOMER][NEUTRAL] And uh the bill amount is $2,851 even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so we do not have a claim on file for this member for those dates of service 442-430, correct? 2024?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Yes sir claim is not on file now because this is.
[CUSTOMER][NEUTRAL] Just oh yeah.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK, it was billed electronically with the pay ID uh.
[CUSTOMER][NEUTRAL] Uh, what's your pay ID?
[AGENT][NEUTRAL] What payer ID do you have?
[CUSTOMER][NEGATIVE] It's incorrect. It's 111. That's 5 times 1.
[AGENT][NEUTRAL] Yes, that is not correct. Uh, the client, our electronic payer ID is 60801.
[AGENT][NEUTRAL] And when the claim is submitted to APL for review, we will also have to have a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK, just in case, can I
[CUSTOMER][NEUTRAL] OK, uh, just in case, can I get the mailing address also?
[AGENT][NEUTRAL] Claims mailing address is going to be [PII].
[AGENT][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK. Uh, attention to?
[AGENT][NEUTRAL] And then Ash claims.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And once we have processed the claim, you should be able to access the explanation of benefits for APL by going to our portal at [PII].
[CUSTOMER][NEUTRAL] OK. Thank you for that. Uh, can I get the initial timely filing limit?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] There's no timely filing limit?
[CUSTOMER][NEUTRAL] Initial timely filing limit, a timely filing limit.
[AGENT][NEUTRAL] There
[AGENT][NEUTRAL] Yes, sir, and I just said there is no timely filing limit.
[CUSTOMER][NEUTRAL] OK, no.
[CUSTOMER][NEUTRAL] OK. Thank you for this information. Can I get the call reference number?
[AGENT][NEUTRAL] My name in today's date.
[CUSTOMER][POSITIVE] OK. Thank you for your assistance. Bye-bye. Have a good day ahead.
[AGENT][POSITIVE] You're welcome. I hope you have a good day as well and thank you again for calling APL.