AccountId: 011433970860
ContactId: 545f0e52-00a8-46d5-8de2-ee251fe96174
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 640659 ms
Total Talk Time (AGENT): 178979 ms
Total Talk Time (CUSTOMER): 215370 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/545f0e52-00a8-46d5-8de2-ee251fe96174_20250318T14:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] A very good morning, [PII]. My name is [PII] and my last initial is [PII]. Well, I'm calling from Avent Health in regards to uh follow-up on an account.
[AGENT][NEUTRAL] OK Miss [PII] and what was the name of the facility you're calling from again please?
[CUSTOMER][NEUTRAL] AdventHealth Orlando.
[AGENT][NEUTRAL] OK, AdventHealth. uh Ms. [PII], um, I can help you with following up on a policy. Can you please give me your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Oh yeah, sure. That would be [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Um, uh.
[CUSTOMER][NEUTRAL] OK. The policy number is 02100152 M as in Mary, L as in Lima, 8, and the first name is [PII], the last name is [PII]. The date of birth is on [PII].
[AGENT][POSITIVE] OK, thank you, let me look that policy up real quick for us.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] You're very welcome. OK, and um you said you wanted to check on the policy. What is it that um I can help you with?
[CUSTOMER][NEUTRAL] Uh, so there's a claim for the date of service, [PII]. So that is denied for primary EOB. So, and we have sent the primary EOB to the mailing address.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh so just wanted to know if the UOB is received by American Public Life.
[AGENT][NEUTRAL] OK, alright, I can check on the claim for you. Can you please give me the charge amount?
[CUSTOMER][NEUTRAL] Yeah, sure. It is for $154 even.
[AGENT][NEUTRAL] OK and then what were the charges after the primary paid?
[CUSTOMER][NEUTRAL] Uh, that would be $75.25.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick call [PII], while I look up this claim for us and I'll be right back.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Ms. [PII], you said that data service was [PII]?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Oh, I'm sorry, I didn't realize I was on mute. So yes, it was for [PII].
[AGENT][NEUTRAL] OK, and you said that you already had the claim go through and it was denied for EOB. Do you have the claim number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, I do have just a moment.
[CUSTOMER][NEUTRAL] So yeah, the claim number.
[CUSTOMER][NEUTRAL] Just a moment here.
[AGENT][POSITIVE] Yes ma'am, take your time.
[CUSTOMER][NEUTRAL] Yeah, the claim number is 3539669.
[AGENT][NEUTRAL] OK, brief hold again. I'm gonna look this up. I'll be right back.
[CUSTOMER][POSITIVE] Yeah, sure. Take your own time.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, Ms. [PII]. So, looking at the claim, it's still asking for a detailed explanation of benefits, and I did notice that um
[AGENT][NEUTRAL] The policy number that you gave me for the claim is different than the original policy number that you gave me.
[AGENT][NEUTRAL] Mm so this claim 353-9669 is under policy number 2544034.
[AGENT][NEUTRAL] So the claim would need to be filed under that policy number with the current with the EOB with the detailed information.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] One moment sorry.
[AGENT][POSITIVE] Sure, go ahead, take your time.
[CUSTOMER][NEUTRAL] Just checking.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Yeah, thank you so much.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yeah, I do see that if we have an insurance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. So we do have an insurance card. I'm checking on that.
[CUSTOMER][NEUTRAL] 000.
[CUSTOMER][NEUTRAL] But uh as per the insurance card, uh, I do see that it is the same thing which I have provided earlier.
[AGENT][NEGATIVE] Right, and that's not the correct policy number.
[CUSTOMER][NEUTRAL] Oh, OK. So, the earlier one was uh
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Rene or something and so with the
[CUSTOMER][NEUTRAL] New member ID is that the case?
[AGENT][NEUTRAL] Right, the member ID is 2544034.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, and just to confirm, there is no 0 in the beginning, right?
[AGENT][NEUTRAL] You can put the 0 there that would be fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, uh, can I have the corrected uh
[CUSTOMER][NEUTRAL] Timely filing limit.
[AGENT][NEUTRAL] There's not one we don't have one.
[CUSTOMER][NEUTRAL] Oh, OK. And can I get the corrected appeal, I mean, mailing address or, yeah, mailing address.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK perfect one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, OK. And can I have the uh pay attention too?
[AGENT][NEUTRAL] Uh, APL claims.
[CUSTOMER][NEUTRAL] APL, right? L as in Lima.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] OK you have claimed.
[CUSTOMER][NEUTRAL] I guess that's all the the information and yeah, may I know if the patient is eligible for the date of service?
[AGENT][NEUTRAL] Let me look
[AGENT][NEUTRAL] The effective date of the policy is
[AGENT][NEUTRAL] Oh wait, that's the old one you gave me. Let me look.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The effective date of the policy is [PII] and the policy is still active.
[CUSTOMER][POSITIVE] Oh my gosh.
[CUSTOMER][POSITIVE] OK, thank you so much for that and can I get the call reference number?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, [PII] and today's date.
[CUSTOMER][NEUTRAL] And can I have your last?
[AGENT][NEUTRAL] A
[CUSTOMER][POSITIVE] OK. Thank you so much, surely. Have a great day ahead. Bye-bye.
[AGENT][NEUTRAL] You're welcome, Ms. [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] OK, well, you have a wonderful day too, and thank you for calling APL.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Bye bye