AccountId: 011433970860
ContactId: b8950aa5-32e8-4a1f-8c4c-8230fa5b0811
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 539739 ms
Total Talk Time (AGENT): 252082 ms
Total Talk Time (CUSTOMER): 281037 ms
Interruptions: 15
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/b8950aa5-32e8-4a1f-8c4c-8230fa5b0811_20250421T14:57_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is So. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII] calling from Advent Health Orlando to check the claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status, Miss [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Thank you. May I have the patient's policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So the patient policy number is going to be 02544034.
[CUSTOMER][NEUTRAL] And could you please spell your name? I didn't get your name.
[AGENT][POSITIVE] Thank
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and date of birth, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] What is the date of service and the amount of the claim?
[CUSTOMER][POSITIVE] Thank.
[CUSTOMER][NEUTRAL] So, it's [PII] and with the total charges of $154 even.
[CUSTOMER][NEUTRAL] X J B H 54.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And for the future, you can check claim status online through our website at [PII] and that's just optional. And let me see if I can find this claim for you.
[CUSTOMER][NEUTRAL] I go yeah.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Do you know what's the procedure code?
[CUSTOMER][NEUTRAL] Oh yes. So the pressure code is going to be.
[CUSTOMER][NEUTRAL] 3641584438005380061.
[CUSTOMER][NEUTRAL] Those are the 4 procedure codes which were filled.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, let me pull the.
[AGENT][NEUTRAL] And it looks like this is the.
[CUSTOMER][NEUTRAL] So, we have submitted the claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Claim on [PII] because one of the representatives previously stated that they need the new member ID so that's why it is denied. So we submitted through like that only as the previous rep stated. So just give me the status of this claim.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] and then you know.
[AGENT][NEUTRAL] OK, Ms. [PII], we processed twice. The last one was processed as a duplicate, so I'm gonna go ahead and pull the original and give you information of the original, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so the original claim was processed [PII].
[CUSTOMER][NEUTRAL] Yeah I
[CUSTOMER][NEUTRAL] So.
[AGENT][NEGATIVE] And it was denied. The reason for this denial?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is that uh we have received the primary explanation of benefit that was submitted with the claim. However, the explanation of benefits received does not list the amount applied towards the deductible co-payment or co-insurance.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So we need an EOB that will show an amount towards the deductible co-payment of co-insurance to reprocess the claim.
[CUSTOMER][NEUTRAL] Mhm. Let me check.
[AGENT][NEUTRAL] If the major medical did not pay, we do not pay, OK?
[CUSTOMER][NEUTRAL] Uh, let me check that. Uh, so in the UB it is clearly mentioned as co-deductible, right? Can you please check the UB ones?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I can go ahead and pull the documents of the most recent one and see if there's anything in there. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She was.
[AGENT][NEUTRAL] OK, on the explanation of benefits that I'm looking at, which is from United Healthcare, it's indicating that there's a reported amount of $154.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] No, let me see, there's not a breakdown of where is that amount applies towards so we don't have any codings like, you know, where you said the procedure codes at 8443 86415. We need a breakdown to know what we're paying. There's nothing breakdown in here.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I'm trying to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, are you able to see whether, uh, that amount which was applied as patient responsibility from the primary. Can you please check that whether it was applied or not, or if, if it is not applied, I'll just go ahead and send you the EOP to your mailing address.
[AGENT][NEUTRAL] Again, uh, we need a detailed explanation of benefits. So I do see there is $75.25 applied towards the deductible, but where do we put that? Do we put that under 8443864158001 where we, you know, we need to know what to apply it to. It's not here.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Ma'am, ma'am, can you please check? Yes, yes, I got your point. For the code 36415, it is mentioned as PR 10.01. And for 84443.
[AGENT][NEUTRAL] It's not here.
[AGENT][NEGATIVE] It's not here, it's not here. I'm not, yeah, the information is not here.
[CUSTOMER][NEUTRAL] OK. So, OK.
[CUSTOMER][NEUTRAL] OK. Can you please provide me the claim number which was received in the month of December last year?
[AGENT][NEUTRAL] OK, um, let's see, the one for December, let's see do do do the claim number is 3539669.
[CUSTOMER][NEUTRAL] And uh what is the claim process uh one second, and the claim number is 3539669, right?
[AGENT][NEUTRAL] The claim number is 3539669, yes.
[CUSTOMER][NEUTRAL] Uh, ma'am, your voice is cutting in and out. The claim number is 3539669. Am I correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. So may I know the denial reason uh as it is requesting for primary you'll be denied date?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The denial reason is indicated that there's not an amount applied towards the deductible. I can only read what's on the EOB, Miss [PII]. I cannot give you information that I don't see. I can only read it.
[CUSTOMER][NEUTRAL] Uh, not, not.
[CUSTOMER][NEUTRAL] Uh, ma'am, I'm not asking about the denial reason, denied date or process date.
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] For which one, the original one or the duplicate one? Because the original one is the [PII], which is the same one you, you, you gave me. [PII].
[CUSTOMER][NEUTRAL] Yes, one.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK. Then what about the new claim number which was received recently?
[AGENT][NEUTRAL] OK, the denial claim number is um for a duplicate is 3585045.
[CUSTOMER][NEUTRAL] OK. May I know the received date and the denied date?
[AGENT][NEUTRAL] On this one was, let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It was received [PII], process [PII].
[CUSTOMER][NEUTRAL] OK, as duplicate, right? And you want the primary EOB clearly uh to which uh the patient portion is applied, right? So can you please help me with your mailing address to receive?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Where they're coding right down.
[CUSTOMER][NEUTRAL] And then.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, the mailing address is [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] for this.
[AGENT][NEUTRAL] The zip code is [PII], yes.
[CUSTOMER][NEUTRAL] Ma'am, can you please
[CUSTOMER][NEUTRAL] [PII], OK. [PII], right?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] What is attention to?
[AGENT][NEUTRAL] Claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what about the timely filing limit to receive?
[AGENT][NEGATIVE] You don't have timely filing in.
[CUSTOMER][NEUTRAL] The UB or to send the UB?
[AGENT][NEUTRAL] We don't have how many family minutes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much for that. And can you please help me with the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers, you can use my name in today's date.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK. Thank you so much for assisting. Have a wonderful day. Bye-bye.
[AGENT][POSITIVE] You're welcome and thank you for calling APM.