AccountId: 011433970860
ContactId: b7ebf89d-e8fd-4bfe-a4cf-0f3ed91c4367
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 533049 ms
Total Talk Time (AGENT): 104424 ms
Total Talk Time (CUSTOMER): 233993 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/b7ebf89d-e8fd-4bfe-a4cf-0f3ed91c4367_20250508T15:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] All right, good morning. My name is [PII] and my last initial is [PII]. I'm calling from Advent Health in regards to claims.
[AGENT][NEUTRAL] OK, I can help you with claim status, [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes. It is [PII].
[CUSTOMER][NEUTRAL] I'm sorry, I'm repeating it again. It is [PII].
[AGENT][NEUTRAL] OK, thank you. And you have the policy number for the patient?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that is 024515.
[CUSTOMER][NEUTRAL] 77
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima.
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] And what was that patient name and date of birth?
[CUSTOMER][NEUTRAL] Um, yes. Uh, so the first name is [PII], the last name is [PII]. The date of birth is on
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And you have the date of service and bill charges?
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, it is for
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII] for the bill amount of $15,472.
[CUSTOMER][NEUTRAL] And 47 cents.
[AGENT][NEUTRAL] OK, and that was [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Alright bye bye bye.
[AGENT][NEUTRAL] OK, could you repeat the bill charges again for me please?
[CUSTOMER][NEUTRAL] Sure. So, it is $15,472.47.
[AGENT][NEUTRAL] OK, looks like we received that claim on.
[AGENT][NEUTRAL] 42925.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Process 51 2025.
[AGENT][NEUTRAL] And we made a payment of $23.31.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, may I know if there is any denial on the claim?
[AGENT][NEUTRAL] Uh, let me pull it up. Hold on one moment. Let's see.
[AGENT][NEUTRAL] It looks like the calendar year maximum for the benefit was exhausted with payment of this claim.
[CUSTOMER][NEUTRAL] Um, is it related to certain CPT code or just, uh,
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Service.
[AGENT][NEUTRAL] It it's just the inpatient services, so the calendar year maximum for inpatient benefits was exhausted with payment of this claim.
[CUSTOMER][NEUTRAL] Calendar your benefits. OK. May I know for, um, is it based on the units or uh the dollar value?
[AGENT][NEUTRAL] Dollar
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Dollar. OK. May I know how much in total?
[AGENT][NEUTRAL] Uh it's 2000.
[CUSTOMER][NEUTRAL] 2000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] See.
[CUSTOMER][NEUTRAL] OK. I do see the payment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] So, um, may I know how much is met for 2000 including this claim?
[AGENT][NEUTRAL] This $23.31 paid the balance of the $2000 so it was paid on previous claims.
[AGENT][NEUTRAL] Not for your provider, so it's paid for a different provider.
[CUSTOMER][NEUTRAL] OK. So now, um, there is no balance left uh for 2000, right?
[AGENT][NEUTRAL] Yes, the, the calendar year maximum of 2000 has been exhausted with this claim. Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, well, actually, can I have your name, please?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] OK. So [PII], uh, it is that, um,
[CUSTOMER][NEUTRAL] We have received you will be, but I, I don't know, it is not showing anywhere regarding this denial. It just shows that the payments were made with no patients responsibility and also no kind of denial or anything. So is it possible for you to fax the AOB to us?
[AGENT][NEUTRAL] Uh, yes, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The 2 calendar.
[AGENT][NEUTRAL] OK, so you didn't receive page 2 of the EOB, is that right?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] What's your fax number?
[CUSTOMER][NEUTRAL] So I don't see. OK. So it is [PII].
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] What accounting.
[CUSTOMER][NEUTRAL] Um, the thing is that.
[AGENT][NEUTRAL] OK, I'll get that faxed over. It just takes a few minutes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So [PII] process on 51, OK. And uh so the denied charges, can I have the denied charges?
[AGENT][NEUTRAL] Um, there's not denied charges. We just, we've received the claim and we paid out the maximum that was left, so 2331 was what was left.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK. So, [PII], I just wanted to get one confirmation that uh the UB which you're sending me, uh, will that state that there is a patient's responsibility where, I mean, sorry, that there are non-covered charges where the maximum benefits has been exhausted. So, can I see that remark codes in the UV that you're sending to me?
[AGENT][NEUTRAL] Yes, it's on the EOB uh-huh.
[CUSTOMER][POSITIVE] OK, OK, perfect, thank you so much for that. I just wanted to, you know, kind of validate, OK.
[CUSTOMER][NEUTRAL] Um, yes, [PII], can I get the call reference number?
[AGENT][NEUTRAL] That's my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] And can I have your last initial, please?
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][POSITIVE] Perfect. Thank you so much, [PII]. Have a wonderful day ahead.
[AGENT][POSITIVE] OK, thank you for calling APL. You too. Bye-bye.