AccountId: 011433970860
ContactId: 6735e16f-aff9-4267-a28c-dd3eef89a960
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 537340 ms
Total Talk Time (AGENT): 207165 ms
Total Talk Time (CUSTOMER): 103716 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/6735e16f-aff9-4267-a28c-dd3eef89a960_20250515T21:16_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, hello, my name is [PII]. Last initial is M calling to get general claim status for a number.
[AGENT][NEUTRAL] Sure, I can assist you with client status, Ms. [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Alright, thank you and may I have the name of the facility you're calling from for my notations?
[CUSTOMER][NEUTRAL] Sir, AdventHealth Medical Group.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure, it's 2549492.
[AGENT][NEUTRAL] All right. And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, date of birth is [PII].
[AGENT][POSITIVE] Mm perfect, thank you.
[AGENT][NEUTRAL] And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, the first one is [PII] with the bill amount of $438.
[AGENT][NEUTRAL] OK, let me see if I can find this one. And for future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] And 438, here we go.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, so it looks like we have received this claim on [PII], processed [PII], and the claim was denied. The denial reason is inpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Were you able to give the patient any type of discount?
[AGENT][NEUTRAL] Not with us because we're just a secondary. What we do is we help with the major medicals, um, deductibles, co-payment, and co-insurance. Uh-huh.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, got you. Um.
[AGENT][NEUTRAL] OK. Do you have another date for him?
[CUSTOMER][NEUTRAL] Yes, uh, [PII], build amount is $320.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, let me pull this one it looks like we probably pay partial on this one.
[AGENT][NEUTRAL] Bear with me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, it looks like this one was processed on [PII] as well and um with this one be paid or we send a benefit amount.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let me make sure it's the right one.
[AGENT][NEUTRAL] How much you said is the total charge on this one?
[CUSTOMER][NEUTRAL] 320.
[AGENT][NEUTRAL] 320. OK, yeah, that one is a different one. OK. It was denied for the same reason on this one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Impatient husband.
[CUSTOMER][NEGATIVE] Um, I do have like 3 more. I'm thinking that these all might be denied as the same.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The next one is uh [PII], so the amount is $847.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Let me try this.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK, so this one you said the total charge was 870?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] OK. So this one was paid, um, it looks like we have processed this one on [PII] and we send a benefit.
[CUSTOMER][NEUTRAL] I'm sorry, give me one moment, I'm sorry, give me one moment, uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh sure.
[CUSTOMER][NEUTRAL] 847, right?
[CUSTOMER][NEUTRAL] I said 8:47. I'm sorry.
[AGENT][NEUTRAL] 8
[AGENT][NEUTRAL] 847.
[CUSTOMER][NEUTRAL] Yeah, [PII], 847.
[AGENT][NEUTRAL] Oh, no, this is not it, OK, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I don't see 14847 and that's just this one, let me pull this other one.
[AGENT][NEGATIVE] OK, yeah, this one was also denied for the same reason.
[AGENT][NEUTRAL] And this one has two days of service, [PII] and [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, the next one is [PII] with a good amount of $640.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK let me OK fine.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so, um, the one for [PII] for, um, the one we have here is not for [PII], it's the one for 3:[PII]. Is it a combined with another one, another date?
[CUSTOMER][NEUTRAL] It is the [PII] date?
[AGENT][NEUTRAL] [PII]. OK, I'm sorry. I put [PII]. OK, bear with me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me pull this up one.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, here it is. It's the [PII] and the [PII] together. OK, so it's denied for the same reason on this one.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, and I have one more, which is [PII]. The amount is $801.
[AGENT][NEUTRAL] 2
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mm
[AGENT][NEGATIVE] OK, so this one was also processed and denied for the same reason, and this is um 2 days, the [PII] and the [PII].
[CUSTOMER][POSITIVE] Alright, thank you so much and can I get a reference number for the call?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] OK, what's your name?
[AGENT][NEUTRAL] My name is [PII]. That's [PII], last initial is [PII].
[CUSTOMER][POSITIVE] Right, thank you so much for your time you have a good day.
[AGENT][POSITIVE] You're welcome. You as well thank you for calling APO.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] All right. Bye-bye. Oh.
[AGENT][NEUTRAL] Mm bye.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] What?