AccountId: 011433970860
ContactId: eb2828fa-4cad-4a8a-af23-b0e9cc98895e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 506070 ms
Total Talk Time (AGENT): 107390 ms
Total Talk Time (CUSTOMER): 235025 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/eb2828fa-4cad-4a8a-af23-b0e9cc98895e_20250529T13:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from Advent Health checking for claim status.
[AGENT][POSITIVE] All right. I'm happy to check on a claim. What is the policy number?
[CUSTOMER][NEUTRAL] Yeah, so the policy number would be 1813059.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name would be [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] the services for [PII].
[CUSTOMER][NEUTRAL] And the bill amount would be $753.83.
[AGENT][NEUTRAL] $753.83.
[CUSTOMER][POSITIVE] Yes ma'am, that's right.
[AGENT][NEUTRAL] OK. One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for your patience on that. So, we did receive a claim on [PII].
[AGENT][NEUTRAL] The claim was denied on [PII]. We need a detailed explanation of benefits from the primary.
[CUSTOMER][NEUTRAL] Um, uh, yes, ma'am. So this was basically a follow-up call. On [PII], 1 of our representatives has, has made a call and, uh, the same was provided to, to the representative that they're requiring for a primary explanation of benefits and we have sent it via mail to the mailing.
[CUSTOMER][NEUTRAL] Address [PII] and it was sent on [PII]. I do have a tracking number as well. I can provide you when you want it. So I was just checking on that appeal whether you have received the primary will be or not, just like that.
[AGENT][NEUTRAL] Let me see one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Do you have a different amount after the primary paid?
[CUSTOMER][NEUTRAL] Uh, so actually, the primary has processed the claim into two split claims. So, uh, uh, so two different split claims combined together the same bill amount. So first split claim, we received an explanation of benefits that they apply towards deductible of $174.50.
[CUSTOMER][NEUTRAL] In the other claim, there was a deductible of $68.48. So altogether, they were summing up to $243.17 as the deductible, but it was processed under the two split claims maybe because of that, you might have not received one claim prior before.
[AGENT][NEUTRAL] OK, so we did receive an EOB on [PII] and then processed a claim on [PII]. There was a benefit payment sent in the amount of $68.48.
[CUSTOMER][NEUTRAL] That was one.
[CUSTOMER][NEUTRAL] Yes, that was one explanation of benefits, $68.48 dollars, and there was one more, which was $174.59.
[AGENT][NEGATIVE] I don't see anything else after that. No, I don't see that we've received anything else.
[CUSTOMER][NEUTRAL] OK, so you're stating that only one explanation of benefit was received.
[AGENT][NEUTRAL] That's what I see on my side, yes.
[CUSTOMER][NEUTRAL] OK, no issues. I'll just send the other one as well. Uh, before that, I just want to verify that, um, so it was a clean was received on [PII] and processed on [PII], and you've only received one explanation of benefits, right?
[AGENT][NEUTRAL] We received the explanation of benefits on [PII], correct, and then processed it on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and the claim which was denied stating the required primary explanation of benefits, the claim number is 3572758, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It was received and processed on the same day of [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. So that, could you please help me with the mailing address so that I'll send you the complete EOB explanation of benefits. Is it the same mailing address which I've provided?
[AGENT][NEUTRAL] Yes, the PO box.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. OK. Just a moment, ma'am. [PII]. OK. OK. Um, ma'am, could you please help me with the timely filing limit for submitting the documents?
[AGENT][NEUTRAL] No
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] No timely silent. OK, got it. OK. Attention to claims, right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK. OK. In that case, um, could you please, uh, is there any specific, uh, number or some document number assigned to the documents what you've received?
[CUSTOMER][NEUTRAL] When we process it.
[AGENT][NEUTRAL] 359.
[AGENT][NEUTRAL] 9115.
[CUSTOMER][NEUTRAL] 359. Could you please repeat that?
[AGENT][NEUTRAL] 359.
[AGENT][NEUTRAL] 9115.
[CUSTOMER][NEUTRAL] Got it. OK, so that is the uh reconfiguration number?
[AGENT][NEUTRAL] That's the claim number for the processed one where we received the EOB.
[CUSTOMER][NEUTRAL] OK, got it. OK.
[CUSTOMER][NEUTRAL] OK. OK, then. That's it for today, ma'am. Could you please help me with the call reference number?
[AGENT][NEUTRAL] Call reference is my name with today's date. My name again is [PII], that's [PII] Last initial is [PII], then today's date.
[CUSTOMER][POSITIVE] OK. That's it for today, [PII]. Thank you so much for assisting. Wishing a wonderful rest of your day. Thank you. Bye for now.
[AGENT][NEUTRAL] You too. Bye-bye.