AccountId: 011433970860
ContactId: bd408c12-ebbc-485a-b150-f8d8194701b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 299540 ms
Total Talk Time (AGENT): 120444 ms
Total Talk Time (CUSTOMER): 98119 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/bd408c12-ebbc-485a-b150-f8d8194701b0_20250312T21:21_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello [PII], my name is [PII]. I'm calling from AdventHealth for general claims status for a member.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] And then the policy number is 23078.
[AGENT][NEUTRAL] Do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] I do not.
[AGENT][NEUTRAL] OK, what's the member's first and last name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Alright, so that's 23078 was the group number, but I believe I found the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Can you verify his date of birth for me?
[CUSTOMER][NEUTRAL] Sure [PII].
[AGENT][NEUTRAL] Alright, and all the information provided is a verification of benefits, not a guarantee of payment. So that policy number is 154.
[AGENT][NEUTRAL] 8251.
[AGENT][NEUTRAL] And this policy has been active since [PII].
[AGENT][NEUTRAL] And may I have the data service for?
[CUSTOMER][NEUTRAL] Let me just verify the member.
[CUSTOMER][NEUTRAL] Sure, I just want to quickly verify the member ID is 1548251.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Yes, ma'am, that's correct.
[CUSTOMER][NEUTRAL] OK, and then that group number you said is 23078, that's the group?
[AGENT][NEUTRAL] Mhm, that's the group number.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] All righty. And the um
[CUSTOMER][NEUTRAL] Um, date of service is [PII].
[AGENT][NEUTRAL] And that's
[CUSTOMER][NEUTRAL] Uh, with the bill amount of $159.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 159 with this one.
[AGENT][NEUTRAL] Can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Um, yes, um, AdventHealth Medical Group.
[AGENT][NEUTRAL] Alright, so I'm trying to receive the claim on [PII].
[AGENT][NEUTRAL] The claim was also processed on [PII].
[AGENT][NEUTRAL] My claim number is 3553846.
[AGENT][NEGATIVE] And it was denied requesting the.
[CUSTOMER][NEUTRAL] I'm sorry, you said?
[AGENT][NEUTRAL] For the claim number?
[CUSTOMER][NEUTRAL] I'm sorry because I'm typing all this out. Yeah, the claim number.
[AGENT][NEUTRAL] 355.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 384 6.
[CUSTOMER][POSITIVE] OK perfect thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEGATIVE] And it was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] 4.
[CUSTOMER][NEUTRAL] Will be primary OK perfect and then I have one more claim it's the same member um.
[CUSTOMER][NEUTRAL] The same data service just a different build amount.
[AGENT][NEUTRAL] OK, and what's that bill amount?
[CUSTOMER][NEUTRAL] $270.
[AGENT][NEUTRAL] Alright, so that claim was received on [PII]?
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 0697.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] As office visits are not covered by this policy.
[CUSTOMER][NEGATIVE] Mhm not covered.
[CUSTOMER][NEUTRAL] OK. So this would be a PR responsibility, a patient responsibility?
[AGENT][NEUTRAL] So we don't determine patient responsibility because we're not the major medical company.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Got you. OK.
[AGENT][NEUTRAL] All right, [PII]
[CUSTOMER][NEUTRAL] So this is also I have to go to primary right? because you're secondary.
[AGENT][NEUTRAL] Right, it would either it would either go to primary or whatever your um policies are for the outstanding or remaining balances.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, thank you and can I have a reference number please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, and what was your um first name again?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] All right. Thank you so much, [PII]. You have a good day.
[AGENT][POSITIVE] You're welcome. You also, and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Mhm thank you bye bye.