AccountId: 011433970860
ContactId: 4eb4c44c-28bf-4d5d-ba82-e682cc37ccb7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 467079 ms
Total Talk Time (AGENT): 186023 ms
Total Talk Time (CUSTOMER): 108940 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/4eb4c44c-28bf-4d5d-ba82-e682cc37ccb7_20250507T14:32_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello. Hi, I'm [PII] calling you from provider's office upon checking general claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status. May I please get your name and your call back number?
[CUSTOMER][NEUTRAL] My name is [PII] Callback number [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] The policy number is 0250.
[CUSTOMER][NEUTRAL] 1560.
[CUSTOMER][NEUTRAL] M for Mary, L for Lima, 7.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The patient named [PII].
[AGENT][NEUTRAL] And the patient
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, it's [PII], date of birth, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me pull that up real quick.
[AGENT][NEUTRAL] OK, and then may I please have the data service and the charge amount?
[CUSTOMER][NEUTRAL] Yeah, it range from [PII].
[AGENT][NEUTRAL] OK, and what is the charge amount please?
[CUSTOMER][NEUTRAL] It's 81,444 dollars.19 cents.
[AGENT][NEUTRAL] Thank you. And then what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] It's 81,444.19.
[CUSTOMER][NEUTRAL] 10.
[AGENT][NEUTRAL] OK. And may I please have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] It's Advent Health Heart of Florida.
[AGENT][NEUTRAL] OK, Miss [PII], I'm going to put you on a quick hold while I look up this claim for us and I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Ms. [PII], you said at the beginning of the call the claim was denied. Can you please give me the claim number?
[CUSTOMER][NEUTRAL] I don't have a claim number.
[AGENT][NEUTRAL] You don't have the claim number, OK, so looking on um data service of [PII].
[AGENT][NEUTRAL] Through [PII] I do not find a claim on file for [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Wait a minute. Let me check one more time.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look one more place. I'm gonna put you on a quick hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 359.
[AGENT][NEUTRAL] 7754.
[AGENT][NEUTRAL] Alright, thank you Ms. [PII]. I did find the claim. Uh, let me give you the claim number.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's 359.
[AGENT][NEUTRAL] 7754.
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] 359-779-4
[AGENT][NEUTRAL] 7754.
[CUSTOMER][NEUTRAL] When did you receive this claim?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] I'll have to check that let me give you the remark on the claim.
[AGENT][NEUTRAL] It's asking for an explanation of benefits with more detailed explanation that shows that the deductible co-pay or co-insurance was paid.
[CUSTOMER][NEUTRAL] We've got
[CUSTOMER][NEUTRAL] Mhm. You mean you're asking for primary UB?
[AGENT][NEUTRAL] And we received.
[AGENT][NEUTRAL] Yes, primary EOB, which we did receive one but it does not explain the benefits received does not list the amounts applied to the deductible copay or co-insurance, so we need an explanation of benefits that shows the amounts that were applied to the deductible copay or co-insurance.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Can you provide me the mailing address?
[AGENT][NEUTRAL] Yes, ma'am, that is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] It ranges from [PII].
[CUSTOMER][NEUTRAL] 731
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we received the claim on [PII].
[CUSTOMER][NEUTRAL] What's the timely filing limit?
[AGENT][NEGATIVE] We received the claim on [PII] and processed it on [PII] and we do not have a timely filing limit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you provide me the fax number?
[AGENT][NEUTRAL] Yes, that is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Please go for the call reference.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][POSITIVE] Yes ma'am you can use my name and today's date.
[CUSTOMER][NEUTRAL] What's your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Can you please repeat your name?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And today's date, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, thank you so much. Have a great day bye bye.
[AGENT][NEUTRAL] You're very welcome, Nada, is there any?