AccountId: 011433970860
ContactId: 98d1965e-e93c-4754-ae11-72cfa6ed828c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 275149 ms
Total Talk Time (AGENT): 107313 ms
Total Talk Time (CUSTOMER): 72996 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/98d1965e-e93c-4754-ae11-72cfa6ed828c_20250528T17:06_UTC.wav
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[AGENT][NEUTRAL] Good afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling from AdventHealth to check on a claim status.
[AGENT][NEUTRAL] OK, now, and you're needing claim status for one claim, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And can you please spell your name for me?
[CUSTOMER][NEUTRAL] Yes, it's [PII] Excuse me.
[AGENT][NEUTRAL] OK, [PII], thank you. And your callback number?
[CUSTOMER][NEUTRAL] Uh yes, it's [PII] direct line.
[AGENT][NEUTRAL] OK, thank you. And you said that you're with Advent ADD ENT Health. Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, thank you. And what is the patient's policy number?
[CUSTOMER][NEUTRAL] Just a moment. Policy number is 01940423.
[AGENT][NEUTRAL] OK, thank you. One moment please while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information I that I do provide today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Date of service is [PII]. Total bill amount is $500.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I do show that this claim was received. [PII], this claim was received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim number is 3559354.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And the reason for the denial state's office visits are not covered by the above numbered policy.
[AGENT][NEUTRAL] The supplemental policy does not cover office visits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefits, [PII], we do have a portal now that you have the claim number that you should be able to print that from and the website for the portal is located at [PII].
[AGENT][NEUTRAL] Dot
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. All right. So you do have a claim, that claim number is 35593554 and it has been denied as the insurance does not cover um office visits.
[AGENT][POSITIVE] Yes, ma'am, that is correct. The supplemental policy, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else, [PII] that I can help you with today?
[CUSTOMER][NEUTRAL] Is there a call reference number, [PII]?
[AGENT][NEUTRAL] You, yes, ma'am. You would use my name along with today's date.
[CUSTOMER][NEUTRAL] OK, and then may I have the initials of your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you. I appreciate it. Have a great day.
[AGENT][POSITIVE] OK. Well, I hope you have a great day too, and thanks that's all I can help you with. Thank you again for calling APL.
[CUSTOMER][NEUTRAL] All right, goodbye.
[AGENT][NEUTRAL] Bye bye.