AccountId: 011433970860
ContactId: e38741a4-841b-4b35-b212-ae414fa48eaf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 181509 ms
Total Talk Time (AGENT): 65328 ms
Total Talk Time (CUSTOMER): 105438 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/e38741a4-841b-4b35-b212-ae414fa48eaf_20250611T19:59_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm with the AdventHealth Medical Group. I wanted to follow up on a claim if I could.
[AGENT][NEUTRAL] OK, and you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] OK, Ms. [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] 02573210
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII] no extension.
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] OK, and what was the data service and amount of the charge?
[CUSTOMER][NEUTRAL] [PII] and that bill was for $535.
[AGENT][NEUTRAL] And do you have the balance after primary?
[CUSTOMER][NEUTRAL] So it looks like it's a $25 you guys are listed as the tertiary, and it's $25 and I'm, I'm betting, I'm betting it's the co-pay, but I just still have to call you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Now give me that, if you had to give me the claim number first, please.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, claim number is 359-581-4.
[AGENT][NEUTRAL] And it looks like the claim is denied as office visits are not covered per the policy.
[CUSTOMER][POSITIVE] Perfect. That tells more information because I have claims that are on file and all it says is denied, noncovered, but it doesn't specify and that makes more sense to me. It's office visits are not covered, OK, per policy so that balance is patient, correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, we can't give patient responsibility. We can only verify what's processed. And, and as far as the EOB, do y'all get, uh, the front and back? Because the back should um have a description of the codes of.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEGATIVE] We don't have anything. We don't have anything. That's why we have to call.
[AGENT][NEUTRAL] Oh,
[AGENT][NEGATIVE] Oh, that's no good.
[CUSTOMER][NEGATIVE] That's, that's why we have to make calls all day because we don't have it. Well, so I don't know what the disconnect is. I guess if we didn't, if we had it, we wouldn't have a job, uh, but, uh, yeah, I make calls all day to see cause nothing is in our system. There's absolutely nothing. They can't.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Uh-huh, yeah.
[CUSTOMER][NEUTRAL] Tell us why it's not, but I make calls all day or look on portals and so that's just what it's set up to be. So yeah, we don't, we don't have it, uh, so that's why I have to call, but I'm OK with that, um, alright, OK, what's your reference number, ma'am?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, my, you can use my name at today's date.
[CUSTOMER][POSITIVE] OK, thank you, ma'am you have a great day.
[AGENT][POSITIVE] Uh, you too. And thanks for calling APL Ms. [PII].
[CUSTOMER][NEUTRAL] OK.