AccountId: 011433970860
ContactId: 667905ad-1f30-4239-a45c-359795da9b89
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 911880 ms
Total Talk Time (AGENT): 203666 ms
Total Talk Time (CUSTOMER): 457163 ms
Interruptions: 16
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/667905ad-1f30-4239-a45c-359795da9b89_20250530T15:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from Advent Health to get the claim status.
[AGENT][NEUTRAL] Can I get your name one more time?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's the policy number?
[AGENT][NEUTRAL] Do you have the policy number with you?
[CUSTOMER][NEUTRAL] Can you hear me?
[AGENT][NEUTRAL] Um, I can now. Do you have your policy, the policy number?
[CUSTOMER][NEUTRAL] It's.
[CUSTOMER][NEUTRAL] Mhm. Yeah. The policy number is 02483142.
[AGENT][NEUTRAL] All right, one moment while I look that up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. Date of birth, um, patient name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And you're wanting claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh what's the date of service or the claim number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, date of service is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] It
[CUSTOMER][NEUTRAL] Amount is $30,473.93.
[CUSTOMER][NEUTRAL] don't know.
[AGENT][NEUTRAL] OK, give me just a moment while I look that up.
[CUSTOMER][NEUTRAL] 541.
[CUSTOMER][NEUTRAL] Uh, mailing address.
[CUSTOMER][NEUTRAL] on.
[CUSTOMER][NEUTRAL] At the back of the.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I'm doing and the uh on the plane.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like we received that claim on [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The.
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim number is 357 8.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 381.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] I mean this is in [PII].
[CUSTOMER][NEUTRAL] Number one number one minute please. Could you hold for a minute please.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] No hello? Mhm.
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Yeah, I can hear you. Yeah.
[CUSTOMER][NEUTRAL] May I get the status claim number please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like we, it looks like we paid $500 to that claim.
[CUSTOMER][NEUTRAL] Is there?
[CUSTOMER][NEUTRAL] Is there anything on this claim that previously we have got to this claim for this claim, but uh we got that um maximum amount allowed for the data service for the member is 500 and more than that it needs to be billed to the patient.
[AGENT][NEUTRAL] We don't determine patient responsibility, but yes, that check um of $500 went to the maximum payable for that date of service. It had been met.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm. What does it mean exactly? I didn't understand.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] It means that their policy only allowed $500 to be paid towards that.
[CUSTOMER][NEUTRAL] But we still have.
[AGENT][NEUTRAL] Um, because they have a maximum benefit amount, and they have, um, used it all up after this check.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So for this one, we are expecting the dollar of
[CUSTOMER][NEUTRAL] One minute. Not that.
[CUSTOMER][NEUTRAL] $30,443.45.
[CUSTOMER][POSITIVE] And a good.
[AGENT][NEUTRAL] Yes, and it went towards their primary insurance and then when it went to us, we paid $500 towards that amount, the amount left over from their first insurance, OK?
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] Yeah, I understand.
[CUSTOMER][NEUTRAL] Yeah, I understand, but um
[CUSTOMER][NEUTRAL] The the remaining amount, what I need to do?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We don't determine patient responsibility, that will be with the provider.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I, I didn't understand, ma'am, what exactly for this, is there any denial on this claim?
[AGENT][NEUTRAL] Yes, we paid $500 towards it.
[CUSTOMER][NEUTRAL] Yeah, yeah, ma'am. Is there any other denial on this claim? Is there any denial, you know?
[AGENT][NEUTRAL] 00 no, there's no denial.
[CUSTOMER][NEUTRAL] No deny. But for, for this one we are having an underpay.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] for this one we are having under way.
[CUSTOMER][NEUTRAL] And that.
[AGENT][NEUTRAL] Yeah, I'm only showing that it was paid. I'm not seeing any denials.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And I can do.
[CUSTOMER][NEUTRAL] Yeah. Mm. So,
[CUSTOMER][NEUTRAL] In.
[CUSTOMER][NEUTRAL] We didn't get any from this. So could you fax the UOB please? OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. What's a good fax number?
[AGENT][NEUTRAL] Can you repeat that please, a little slower?
[CUSTOMER][NEUTRAL] I know. OK.
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] 130.
[CUSTOMER][NEUTRAL] It's like.
[AGENT][NEUTRAL] All right, I just sent that fax for you.
[CUSTOMER][NEUTRAL] Yeah. May I get the turnaround time to get that uh you will be?
[AGENT][NEUTRAL] Um, I just sent it. I just sent the fax, so give it, um, uh.
[CUSTOMER][NEUTRAL] Yeah. OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Until the end of the hour.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It, it will get in one, in one hour, right?
[AGENT][NEUTRAL] Yes, it should be coming any moment. I just sent it but give it um.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Give it about an hour just in case.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So for this one, we are expecting, we have built the claim with uh $30,473.93 but you have allowed $500.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So the remaining amount shall I bill to patient?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, we don't determine that. That will be up to the provider.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] So what I have to do for this claim then, ma'am we are underpaid, right?
[CUSTOMER][NEUTRAL] 0.
[AGENT][NEUTRAL] Uh, the provider will either bill the patient or they will handle it.
[CUSTOMER][NEUTRAL] Hey, you know.
[AGENT][NEUTRAL] We don't determine that.
[CUSTOMER][NEUTRAL] Shall we?
[AGENT][NEUTRAL] Um, you can appeal.
[CUSTOMER][NEUTRAL] A as in
[AGENT][NEUTRAL] You will need to wait 180 days to file an appeal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Like the last one.
[CUSTOMER][NEUTRAL] OK let me know.
[CUSTOMER][NEUTRAL] One minute, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Are you still there?
[CUSTOMER][NEUTRAL] Yeah, I'm here. Thank you for being on hold. May I get your name, please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] My name is [PII], last initial [PII]
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And I did show that the fax just sent to you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. May I get um call reference number?
[AGENT][NEUTRAL] So we don't have call reference numbers but you can use my name and last initial in today's date.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK. So, is there any patient responsibility on the, in the UOB?
[AGENT][NEUTRAL] Um, we don't determine that, so it will be up to the provider.
[CUSTOMER][NEUTRAL] Yeah, you're saying that uh we allowed for, we allowed only $500 right? But we have billed, did you get my bill amount over there? Bill amount is $30,473.93.
[AGENT][NEUTRAL] We did. Mhm.
[AGENT][NEUTRAL] Yeah I did.
[AGENT][NEUTRAL] Yes, and that's on the EOB as well.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Um, um, you have EOB, right? In your EOB, did you have any patient responsibility?
[AGENT][NEUTRAL] On the EOB.
[CUSTOMER][NEUTRAL] Co-insurance, deductible or co-pay?
[AGENT][NEUTRAL] Uh, on the EOB it just shows what was covered, what was paid, and um it doesn't have the remainder or the patient responsibility. That will be up to the provider, but it does have um a way to file an appeal, and it does have uh what was charged and what we paid.
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, I have it.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] And the reasoning for it.
[CUSTOMER][POSITIVE] OK. Thank you. Bye-bye. Have a nice day.
[AGENT][POSITIVE] Great, thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Alright.