AccountId: 011433970860
ContactId: d35c800f-59aa-47de-b58d-d7443577623f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 669000 ms
Total Talk Time (AGENT): 167048 ms
Total Talk Time (CUSTOMER): 218395 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/d35c800f-59aa-47de-b58d-d7443577623f_20250318T14:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from provider office.
[AGENT][POSITIVE] Hi [PII], how are you doing today?
[CUSTOMER][POSITIVE] I'm doing good, thank you for asking. How about you?
[AGENT][NEUTRAL] [PII], are you there?
[CUSTOMER][NEUTRAL] 76
[CUSTOMER][NEUTRAL] Yes, hi.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Hello, can you hear me?
[AGENT][NEUTRAL] I can hear you, yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, so I'm looking for a claim status.
[AGENT][NEUTRAL] OK, you're looking for claim status. [PII], what is your callback number just in case our call gets disconnected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then can you give me the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure, I'll start with the policy number which is 01940423 and my name is [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK, let me pull up that policy number.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, I think it's going.
[CUSTOMER][NEUTRAL] D for Delta.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 1909.
[CUSTOMER][NEUTRAL] 64,800.
[AGENT][NEUTRAL] OK, I've got it pulled up can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] The date of service is [PII] with the bill amount of $8,193.63.
[AGENT][NEUTRAL] OK thank you and then what is the charge amount after the primary insurers paid their part?
[CUSTOMER][NEUTRAL] Um, you mean the remaining balance which second we should pay?
[CUSTOMER][NEUTRAL] I thought that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] So as you primly paid and the the patient responsibility was $300.
[AGENT][POSITIVE] Thank you so much. And then what is the name of the facility you're calling from, please?
[CUSTOMER][NEUTRAL] Advent Health Com Post.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, can you spell that for me please, ma'am?
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Sure. Advent, I'll spelled as A Alpha, D Delta, V Victor, E Echo, and New York, T Tango, H Hotel, E Echo, A Alpha, L Lima, T Tango H Hotel. Then it's Palm Coast spelled as P Papa, A Alpha, L Lima Mike, C Charlie, O Oscar, A Alpha Sierra Tango.
[AGENT][POSITIVE] Thank you. I appreciate that so much. I'm gonna put you on a quick hold while I look up this claim for you and I will be right back.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thanks so much for holding for me and I've got the claim pulled up for you.
[AGENT][NEUTRAL] My number is 356-557-0.
[CUSTOMER][NEUTRAL] Uh, just a moment.
[CUSTOMER][NEUTRAL] Can you repeat the claim number again?
[AGENT][NEUTRAL] It's 356-557-0.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the claim was denied because the maximum benefit for that date of service had been met.
[CUSTOMER][NEUTRAL] So, so.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So the, the, they are saying that the maximum benefit have this they will not make any payment for this?
[AGENT][NEUTRAL] Right. Because in for, for that benefit, it has to be a gap of 90 days before
[AGENT][NEUTRAL] That benefit can be claimed again.
[AGENT][NEUTRAL] So the benefit had already been paid within that 90 days.
[CUSTOMER][NEUTRAL] Can I know when was it paid if possible?
[AGENT][NEUTRAL] No, ma'am, that's private information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No problem. Thank you for that.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So just to confirm this code, um.
[CUSTOMER][NEUTRAL] CT scan code 74176 can only be billed after the 90 days.
[AGENT][NEUTRAL] Right, every 90 days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If you don't mind, can you give me a moment? I'll just try to check it the customer within 90 days, but I have any information regarding that.
[AGENT][NEUTRAL] OK, um, just so you know though it may have been a facility that was not yours.
[CUSTOMER][NEUTRAL] Oh, no problem, I will try to see if you are available.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, OK, yes, I can see it was built on the, uh, in the same month.
[CUSTOMER][NEUTRAL] If I can provide you that claim number, can you just confirm?
[AGENT][NEUTRAL] Uh, yes, what is the claim number?
[CUSTOMER][NEUTRAL] Uh, under which the same code is paid, it's 3,559,360.
[AGENT][NEUTRAL] Let me look real quick.
[CUSTOMER][NEUTRAL] Also, the date of service is [PII].
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] If, uh, so just wanna confirm so as this benefit is reached and they will not make any payment, uh, just a moment.
[CUSTOMER][NEUTRAL] If you don't mind, can we appeal on this if we don't agree with this?
[AGENT][NEUTRAL] I'm sorry, your, your um microphone is not clear.
[CUSTOMER][NEUTRAL] I'm sorry, sorry, I'm saying can we appeal on this if we don't agree with this.
[AGENT][NEUTRAL] Can you, uh, um, maybe I don't understand the question. Can you uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry, I'll repeat my question again. Can we appeal for this claim if we don't agree with this?
[AGENT][NEUTRAL] Absolutely, let me give you um the information. You have 180 days from the date the claim was initially processed and you'll also need to send a letter why you want to appeal.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Can I have the mailing address, please?
[AGENT][NEUTRAL] Yes, ma'am, it's [PII] and that's [PII].
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][POSITIVE] Thank you so much for that. Uh, one last thing, can I just have the claim?
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Claim received and processed it.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] The claim was received on [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And it says on [PII].
[CUSTOMER][POSITIVE] Thank you so much. And the last thing, can I have your your iPhone?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, [PII], in today's date.
[CUSTOMER][POSITIVE] Thank you so much for for all the health information you provided. I really appreciate that.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] You're very welcome, [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] That is all right on my side. Thank you.
[AGENT][POSITIVE] You're welcome you have a wonderful day and thanks for calling APL.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye-bye.