AccountId: 011433970860
ContactId: 61851ad9-c7d8-4b0b-8703-3ccd451bae84
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 474269 ms
Total Talk Time (AGENT): 165370 ms
Total Talk Time (CUSTOMER): 156761 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/61851ad9-c7d8-4b0b-8703-3ccd451bae84_20250319T18:39_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from AdventHealth.
[AGENT][NEUTRAL] OK, and how may I assist you today, [PII]?
[CUSTOMER][NEUTRAL] Yeah, I'm calling for a claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you. And what is that policy number, please?
[CUSTOMER][NEUTRAL] And could you please spell your name?
[AGENT][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] Yup, thank you. And my last initial is [PII].
[AGENT][NEUTRAL] OK, and what's the policy number?
[CUSTOMER][NEUTRAL] Yeah, it is 019.
[CUSTOMER][NEUTRAL] 128
[CUSTOMER][NEUTRAL] 60, M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] Thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][NEUTRAL] Thank you. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Yeah, the member's name is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] And what was the um
[AGENT][NEUTRAL] What was the uh the name again? or verify that policy again or do you have a copy of the card because the number you gave me doesn't show this patient.
[CUSTOMER][NEUTRAL] Hold 1 2nd.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, the member's name is [PII].
[AGENT][NEUTRAL] Is it [PII]?
[CUSTOMER][NEUTRAL] No, it's [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] That's cool.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I do not show that patient in our system. You said [PII], correct?
[AGENT][NEUTRAL] For the first name?
[CUSTOMER][NEUTRAL] Yes, [PII] Yes, and the last name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yes, sir. I don't show that person in our system. Uh, do you have a copy of their card in front of you?
[CUSTOMER][NEUTRAL] Yeah, I'm having the card.
[AGENT][NEUTRAL] And it shows American Public Life or APL.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] And do you see a policy number or policy certificate number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what is that number?
[CUSTOMER][NEUTRAL] Can I go with that one again. Yeah, it is 01912860. M as in Mike, L as in Lima.
[AGENT][NEUTRAL] 2860.
[CUSTOMER][NEUTRAL] Yes, M as in Mike, L as in Lima, and [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, and what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Yeah, data service is on [PII]. And total charge amount is 500. 1 2nd. Yeah, it is.
[CUSTOMER][NEUTRAL] 5 $5,279.15.
[AGENT][NEUTRAL] And what was the balance after Primary process the claim?
[CUSTOMER][NEUTRAL] Yeah, it is $100.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And while I'm looking at claim information, just to let you know, we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what's the name of the provider's office?
[CUSTOMER][NEUTRAL] One second, it is.
[CUSTOMER][NEUTRAL] Yeah, it's AdventHealth Orlando.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What was that, uh, secure.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and it looks like the claim process as the benefit was applied towards the insured's outpatient deductible for ER.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, correct. So,
[CUSTOMER][NEUTRAL] The claim was denied as non-core charges may know under member plan or providers plan it was denied as non-core charges.
[AGENT][NEUTRAL] It wasn't denied as not covered. It processed as the benefit, which is $100 was applied towards the insured's ER deductible.
[CUSTOMER][NEUTRAL] No, one second.
[CUSTOMER][NEUTRAL] Yeah, the primary Blue Cross processed and paid off $1,934.06 patient liability of $100 of copay.
[CUSTOMER][NEUTRAL] And the second, uh.
[AGENT][NEUTRAL] Uh-huh, and the $100 was applied towards the insured outpatient deductible that they have with our company. The insured has an ER deductible of $100 and that $100 benefit was applied towards their deductible.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] One second, allow me a moment.
[CUSTOMER][NEUTRAL] Could you please uh provide me the claim number?
[AGENT][NEUTRAL] 3558732.
[CUSTOMER][NEUTRAL] 3558732.
[CUSTOMER][NEUTRAL] 735-587-32. OK. And could you please send me that uh UP to my fax number?
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] Yeah, it is [PII] and attention to my name.
[AGENT][NEUTRAL] OK, you said the fax number is [PII]?
[CUSTOMER][NEUTRAL] No, it's [PII].
[AGENT][NEUTRAL] [PII]. OK, so [PII], correct?
[CUSTOMER][POSITIVE] Yes, correct.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK. And is there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] OK. Uh, within how much time I will receive that?
[AGENT][NEUTRAL] I give it about 5 to 10 minutes, but definitely before the end of the day.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Please provide me call this number.
[AGENT][NEUTRAL] We don't give reference numbers. If you like, you may use my name in today's date.
[CUSTOMER][POSITIVE] OK. Thank you for providing the information. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Bye.