AccountId: 011433970860
ContactId: bbaf700d-f409-426a-ab89-d49ffbc42a0e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 494079 ms
Total Talk Time (AGENT): 121639 ms
Total Talk Time (CUSTOMER): 107126 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/bbaf700d-f409-426a-ab89-d49ffbc42a0e_20250328T15:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office. Could you help me with the claim status?
[AGENT][POSITIVE] Yes, Ms. [PII], I can help you with the claim status.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Can I please get your callback number just in case our call gets disconnected?
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII], and can I please get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Policy number is 01940423. And the name is [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK, thank you. And let me pull up [PII]'s policy real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Date of services for [PII]. Total charge $3740.21.
[AGENT][NEUTRAL] OK, and then what's the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] That's $350.
[AGENT][NEUTRAL] Thank you and can you please give me the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] That's gonna be AdventHealth, Palm Coast Parkway.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up that claim for us and I'll be right back.
[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, Ms. [PII], for holding for me. I have the claim for you. The claim number is 35593777.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim was denied because the maximum amount payable for this occurrence has been met. So per occurrence there needs to be a gap of 90 days in between occurrences.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For treatment of the same or related condition.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For the patient's policy.
[CUSTOMER][NEUTRAL] OK. And uh it was
[CUSTOMER][NEUTRAL] OK. And it was billed, and it was meant for which state of service?
[AGENT][POSITIVE] Yes, the maximum was met.
[CUSTOMER][NEUTRAL] OK. And um what was the claim number for which the amount was paid?
[AGENT][NEUTRAL] Uh, it wasn't paid because there wasn't a 90 day gap in between occurrences for the same or related condition.
[CUSTOMER][NEUTRAL] Yes. Um, I'm asking that what was the other claim that was paid?
[AGENT][NEUTRAL] Let me look and see if it was for you or not.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] The claim number for the one that was paid, let me see if it's got the same.
[AGENT][NEGATIVE] That's not the same. It was not for you, so I can't give that information.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. And um could you please fax us the denied EOP?
[AGENT][NEUTRAL] Absolutely, let me get that pulled back up again. What is your fax number?
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I get that fax ready for you. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Come on, pop up.
[AGENT][POSITIVE] Thank you for holding for me, Ms. [PII]. I've got that fax on its way to you now.
[CUSTOMER][NEUTRAL] OK. And um so I think we should be receiving it, right? With the end of the day?
[AGENT][POSITIVE] Oh, absolutely.
[CUSTOMER][POSITIVE] OK. Thank you so much for that. And could you just give me a reference number?
[AGENT][NEUTRAL] Yes ma'am, you can use my name. It's [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you so much for that and have a great day. Bye-bye.
[AGENT][POSITIVE] You too, Ms. [PII] have a wonderful weekend and thank you for calling APL. Bye bye.