AccountId: 011433970860
ContactId: 35766cc6-d6d5-4598-a596-4396cf509f26
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 574010 ms
Total Talk Time (AGENT): 183090 ms
Total Talk Time (CUSTOMER): 182503 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/35766cc6-d6d5-4598-a596-4396cf509f26_20250528T19:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from AdventHealth Orlando. I have a claim I need to get status on, please.
[AGENT][NEUTRAL] Alright, [PII], happy to check on a claim. What is the policy number?
[CUSTOMER][NEUTRAL] It is 2549492.
[AGENT][NEUTRAL] Right, and the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you and then what's the date of service?
[CUSTOMER][NEUTRAL] That would be [PII], and it's for [PII].
[AGENT][NEUTRAL] And you said [PII], correct?
[CUSTOMER][POSITIVE] Yes, correct.
[CUSTOMER][NEGATIVE] The when I pulled it up on the portal it just it gave me an EOB that said um it denied because this had already been processed and I don't have any other that's the only claim that showed up on the portal.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So I'm not sure if there's another one that's just not on the portal or if that's an it's an error.
[AGENT][NEUTRAL] Huh, OK. Yeah, there's no no information on it. Let me see.
[AGENT][NEUTRAL] Trying to see if there was usually they'll put in the remarks like if there's another claim number somewhere.
[AGENT][NEUTRAL] Trying to see if there's another one associated maybe with it.
[CUSTOMER][NEUTRAL] I didn't see one on the EOB that's why I was trying to call to see if maybe that was a mistake or to get the other claim number.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, and I apologize, [PII], what was the bill amount again?
[CUSTOMER][NEUTRAL] $753.83.
[AGENT][NEUTRAL] I think it went to this other policy that was active on the date of service. I think that's where the error has happened here.
[AGENT][NEUTRAL] Let me just
[CUSTOMER][NEUTRAL] Did you have two policies that overlap each other?
[AGENT][NEUTRAL] No, so.
[AGENT][NEUTRAL] This one policy, uh, the effective date was up until [PII], and then that policy number that you gave me, that new effective date was 111 of 24. So since the date of service is back on [PII], it needs the claim needed to be under uh the other policy number since it was effective at the date of service, yeah.
[CUSTOMER][NEUTRAL] Oh, gotcha.
[CUSTOMER][NEUTRAL] OK, OK, gotcha.
[AGENT][NEUTRAL] Yeah, so I'm just adding these um amounts up here to make sure this is the right claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, I think it's 2 of them.
[CUSTOMER][NEUTRAL] I don't know why it's got this why it's got split up, but it did with the primary so that's how they paid it, but.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Is it the same ID number or different ID number?
[AGENT][NEUTRAL] It's a different ID number it's um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you want it just to have for your records?
[CUSTOMER][POSITIVE] Yes, please. Yes.
[AGENT][NEUTRAL] It's 181.
[AGENT][NEUTRAL] 3059.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And this policy effective date was [PII], and then up until [PII].
[CUSTOMER][NEUTRAL] OK, and then the other one is effective [PII] and active, the one that I actually gave you? OK, OK, gotcha. All right.
[AGENT][NEUTRAL] Mhm. Correct. Mhm, yup.
[AGENT][NEUTRAL] All right, so I found the duplicate claim. Let me just find the original now here. Sorry.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the original claim, it looks like we did get, um, it was denied requesting the EOB from their primary since we're their secondary.
[CUSTOMER][NEUTRAL] OK, so you still need that primary EOB?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, is there a fax number I can fax them to?
[AGENT][NEUTRAL] Absolutely. It's [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] 3.
[CUSTOMER][NEUTRAL] OK, and um what's the claim number for that one and the received date?
[AGENT][NEUTRAL] Um, so this claim was received [PII].
[AGENT][NEUTRAL] And the claim number on that is 3572758.
[CUSTOMER][NEUTRAL] OK. Alright, and let me have you one, let me ask you one more question. Um, do you guys accept single case agreements?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] A letter of agreement or anything like for um.
[CUSTOMER][NEUTRAL] Do you know what I'm talking about? If not, I can kind of explain it to you.
[AGENT][NEUTRAL] No, no, I have never heard of that.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Sometimes when we get to a point where we um want to settle some claims it's like a settlement um we will offer 60% of total charges, not on this one because it's too small we're not gonna deal with this one but.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, on some claims that are high dollars, we actually do agreements for 60%, 70%, sometimes even as low as 50% for, um, of, of the total charges. Um, is that something that your company would be interested in doing if we run into anything that's like over $10,000? Or do you think no?
[AGENT][NEUTRAL] I have not heard of us ever doing that, um, as far as any, yeah, any sort of agreements or anything like that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, when it comes to the secondary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and you're always secondary, correct?
[AGENT][NEUTRAL] Mhm, yeah.
[CUSTOMER][NEUTRAL] OK, got you. That's probably why because usually we don't do single case agreements for secondaries anyway, but I just thought I would just throw it out there and ask, but since you told me that you're only secondaries, it probably wouldn't, it's like AARP. They don't do secondaries either because they are usually secondary to Medicare. So, but, um, OK, well thank you so much. Do you have a reference number for me?
[AGENT][NEUTRAL] Oh, right.
[AGENT][POSITIVE] I got you.
[AGENT][NEUTRAL] Absolutely. Call references my name with my last initial and then today's date. My name again is [PII], so that's [PII] Last initial to my name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, [PII], thank you so much for your help. You have a great day, OK?
[AGENT][NEUTRAL] You too, bye bye.