AccountId: 011433970860
ContactId: 84fe220b-2e29-492b-ba5b-27fc17004230
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 594770 ms
Total Talk Time (AGENT): 162334 ms
Total Talk Time (CUSTOMER): 163748 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/84fe220b-2e29-492b-ba5b-27fc17004230_20250214T17:29_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hello [PII], my name is [PII] and I'm calling from Advent Health Heart of Florida to know what the claim status.
[AGENT][NEUTRAL] OK, I can help you and um with the claim status, can I get your name again please?
[CUSTOMER][NEUTRAL] Yeah, sure. My name is [PII]. It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what is your callback number, sir?
[CUSTOMER][NEUTRAL] Uh, it's [PII]. It's a direct line.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] OK, thank you. I appreciate you giving me that information. And what is the patient's name?
[CUSTOMER][NEUTRAL] Uh, the patient's name is [PII].
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Yes. And can you repeat your name for me?
[AGENT][NEUTRAL] And then what is
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Um, it's
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And his policy number?
[CUSTOMER][NEUTRAL] Um, 02462238 M as in Mary, L as in Lima, and number 8.
[AGENT][NEUTRAL] Thank you and what is the date of service?
[CUSTOMER][NEUTRAL] Um, the date of service is [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] $13,358.40.
[AGENT][NEUTRAL] OK, and then what's the charges after primary paid their part?
[CUSTOMER][NEUTRAL] Um, primary paid $1,625.88 and it uh adjusted $10,232.52. That's a provider discount and it transferred out 1500 $1500.
[CUSTOMER][NEUTRAL] And uh um
[CUSTOMER][NEUTRAL] Yeah, we have received $750.
[CUSTOMER][NEUTRAL] Uh, from your insurance and uh there is $750 remaining.
[AGENT][POSITIVE] OK, thank you so much. I'm going to pull this claim up for us and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], this is [PII] back with you again. I do find the claim. The claim number is 353-6730.
[CUSTOMER][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you're correct, it did pay $750 with check number 2016491. The check has cleared. Um, after that $750.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was paid it maxed out the benefit for the calendar day for this.
[AGENT][NEUTRAL] But for this claim.
[CUSTOMER][NEUTRAL] Uh, I didn't get you. Can you please repeat that?
[AGENT][NEUTRAL] Yes, it maxed out the benefit for the calendar day for this claim after the $750 was paid. It maxed the benefit.
[CUSTOMER][NEUTRAL] Uh, of this claim, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] So, uh, you're not gonna pay this amount.
[AGENT][NEUTRAL] No, we've already paid, no, we've already paid our part.
[CUSTOMER][NEUTRAL] The remaining amount.
[CUSTOMER][NEUTRAL] Uh, but our expected loan amount is more, right? It's 1500 $1500 because primary paid uh 16 to 5.88 and it transferred remaining to secondary. So secondary should pay the complete amount, right?
[AGENT][NEUTRAL] No, we paid our part of $750.
[CUSTOMER][NEUTRAL] Uh, but we're still expecting, uh, so what can we do to, uh, get this payment? Is there any alternative?
[AGENT][NEGATIVE] Not with us, no.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Uh, OK, sure. Uh, can you just confirm me, are you are you a participating, are you a participating provider or non-participating provider for your insurance?
[AGENT][NEUTRAL] Can I do what?
[AGENT][NEUTRAL] I'm sorry, I didn't understand the question.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, are, uh, is Advent Health out of [PII] is a participating provider for your insurance?
[AGENT][NEUTRAL] The um policy is based on what the primary pays. The insured can use the policy wherever they want to.
[CUSTOMER][NEUTRAL] Uh, can you confirm me, are you a reference-based payer?
[AGENT][NEUTRAL] Am I what?
[CUSTOMER][NEUTRAL] Reference-based payer.
[AGENT][NEUTRAL] No we're not it's based on what the policy.
[AGENT][NEUTRAL] states for the patient.
[CUSTOMER][NEUTRAL] OK, sure. Uh, can you send us an appeal because, yeah, you know, there's an underpayment on this claim and we're expecting that amount from your insurance. Can you send us an appeal?
[AGENT][NEUTRAL] And the patient.
[AGENT][NEUTRAL] Uh, the policy contract states that the patient has an outpatient benefit per calendar day of $750. We paid the $750 but if you would like to appeal, you can, um, you have 180 days from the date of service and you need to send a letter as to why you want to appeal the claim.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] Uh, and what's the mailing address for that?
[AGENT][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure. Thank you for that information. Um, can you give me the call reference number?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, sir, you can use my name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK, sure. Thank you so much for that information. Have a nice day.
[AGENT][POSITIVE] You too thank you and you take care and have a good [PII] and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye-bye, sir.