AccountId: 011433970860
ContactId: a8ee3d39-97fa-47ce-8824-7ca290cf1090
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 465130 ms
Total Talk Time (AGENT): 146272 ms
Total Talk Time (CUSTOMER): 145257 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/a8ee3d39-97fa-47ce-8824-7ca290cf1090_20250505T19:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from provider's office. I'm calling to check with the claim status. Uh, previously, we have sent an appeal, so just want to get the appeal status.
[AGENT][NEUTRAL] OK, I can help you with claim status, Miss [PII]. Can I please get your callback number just in case our call is disconnected.
[CUSTOMER][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] American Public.
[CUSTOMER][NEUTRAL] Patient's name, uh [PII]. Date of birth [PII] and the member ID 20, sorry, I do apologize. The member ID is 02462238. M as in Mike, L as in Leo, 8.
[AGENT][NEUTRAL] OK, thank you. Let me look that policy up real quick.
[AGENT][NEUTRAL] Alright, and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] Sorry, the charge amount, the date of service uh [PII] and the member date of birth is uh
[CUSTOMER][NEUTRAL] The data service is 107-2024. I do apologize.
[AGENT][NEUTRAL] OK, so the day to start.
[CUSTOMER][NEUTRAL] And the charge amount 2700.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Go ahead. Go ahead.
[CUSTOMER][NEUTRAL] The charge amount is $2760.06.
[AGENT][NEUTRAL] OK, and the date of service was [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, that [PII].
[AGENT][NEUTRAL] OK, and then what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh yes. Uh, primary has paid $454.55 and left the patient responsibility of 1000 co-pay.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 1000 co-pay. And uh
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] AdventHealth Heart of Florida.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold, Miss [PII], while I look up this claim and I'll be right back with you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, Ms. [PII]. I do have the claim. The claim number is 3.
[CUSTOMER][NEUTRAL] Could you please
[CUSTOMER][NEUTRAL] Mhm. Could you please spell your name for me?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] Mhm. Loser.
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim number is 353-0360.
[AGENT][NEUTRAL] The claim was paid $750.
[CUSTOMER][NEUTRAL] Yes, I
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] With check number 2013855, the check cleared the bank on [PII]. After that payment, it maxed out the benefit for the insured.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][POSITIVE] With that payment it maxed out the benefit.
[CUSTOMER][NEUTRAL] After the payment?
[AGENT][POSITIVE] Yeah, it maxed out the benefit for the insured.
[AGENT][NEUTRAL] Um
[AGENT][NEGATIVE] It exhausted the benefit with that payment.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, then it's for exhausted, right? OK. Uh, may I know previously, uh, how many, uh, how many units of
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Patient has used a number of you needs, the number of visits and the dollar amount?
[AGENT][NEUTRAL] It doesn't go by units.
[CUSTOMER][NEUTRAL] OK. About the visits, what about the visits?
[AGENT][NEUTRAL] It is 700 and this is verified benefits. It's not guaranteed they get 700 and.
[CUSTOMER][NEUTRAL] Your voice was in and out. Your voice was in and out?
[AGENT][NEUTRAL] They get paid $750 per calendar.
[AGENT][NEUTRAL] On that day, the $750 was paid.
[CUSTOMER][NEUTRAL] Your voice was in and out. Your voice is not clear, ma'am. Hello. Hello, can you hear me? But I cannot hear you.
[AGENT][NEUTRAL] OK. All right, just one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, may I know how many, uh, uh, visits?
[CUSTOMER][NEUTRAL] There's the patient I've met?
[AGENT][NEUTRAL] I'm sorry, can you repeat the question? I'm here.
[CUSTOMER][NEUTRAL] To there.
[CUSTOMER][NEGATIVE] You stated that benefits were exhausted, right? May I know the number of visits which uh the pain has uh um uh reached me.
[AGENT][NEUTRAL] OK, it doesn't go by number of.
[CUSTOMER][NEUTRAL] The number of your needs.
[AGENT][NEUTRAL] OK, it doesn't go by units, it goes by on this policy and this is just to verify benefits. It's not a guarantee of payment. They get $750 per calendar day, so the maximum benefit for that calendar day was met.
[AGENT][NEUTRAL] And paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. The remaining $250 is responsible by the patient, right?
[AGENT][NEGATIVE] We do not give patient responsibility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Call reference number?
[AGENT][NEUTRAL] Yes ma'am, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you. Have a good day. Bye-bye.