AccountId: 011433970860
ContactId: fae4376c-55dd-418b-983d-851a258d5aa0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 343529 ms
Total Talk Time (AGENT): 134652 ms
Total Talk Time (CUSTOMER): 110097 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/2025/06/17/fae4376c-55dd-418b-983d-851a258d5aa0_20250617T19:52_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] and I'm calling from AdventHealth Heart of Florida to know the claim status. Can you repeat your name for me?
[AGENT][NEUTRAL] OK, sure. My name is [PII]. That's [PII]. That's initial is [PII]. And may I have the spelling of your name?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have a callback number just in case we get disconnected on Mr.
[CUSTOMER][NEUTRAL] Sure. It's [PII]. It's a direct line.
[AGENT][NEUTRAL] And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. The patient's policy number is 02501560ML7.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and you say you need claim status. What is the data service and the amount of the claim?
[CUSTOMER][NEUTRAL] Data services [PII] [PII].
[CUSTOMER][NEUTRAL] And uh total bill amount is $81,444.19.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for you. And for future you can share claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure. Sure.
[AGENT][NEUTRAL] OK, let me pull this moment.
[AGENT][NEUTRAL] It looks like we received the claim on [PII] and process on [PII].
[AGENT][NEUTRAL] And the claim, um, it looks like we received the explanation of benefits attached to it, but there is no amount applied towards the deductible copayment or co-insurance.
[AGENT][NEUTRAL] So we need a detailed explanation of benefits to be sent out to us.
[CUSTOMER][NEUTRAL] So the claim is paid or not?
[AGENT][NEUTRAL] We have processed the claim.
[AGENT][NEUTRAL] Based on the information we received, the explanation of benefits does not list the amount applied towards the deductible co-payment of co-insurance.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] I couldn't get, I couldn't
[CUSTOMER][NEGATIVE] Excuse me, I couldn't hear your voice properly.
[CUSTOMER][NEUTRAL] There's a lot of buzz in your voice.
[AGENT][NEUTRAL] OK, we need a uh.
[AGENT][NEUTRAL] OK, we need a detailed explanation of benefits to continue the processing of this claim.
[CUSTOMER][NEUTRAL] Uh, the prime, the primary extension of benefits, primary insurance?
[AGENT][POSITIVE] Correct. Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure. And uh how can I send you the explanation of benefits? What's the mailing address?
[AGENT][NEUTRAL] You can send it by fax or mail.
[CUSTOMER][NEUTRAL] Yeah. Uh, can I get the mailing address?
[AGENT][NEUTRAL] Sure. The mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK. You said [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] And what's the time defining limit to send that?
[AGENT][NEUTRAL] Um, there's no timely filing limits for it to submit a primary EOB.
[AGENT][NEUTRAL] The EOB needs to show the amount applied towards the deductible co-payment or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] Do you need the claim number or any other information?
[CUSTOMER][NEUTRAL] Uh yes, I need the claim number and uh the call reference number.
[AGENT][NEUTRAL] OK, the claim number is 3597754.
[AGENT][NEUTRAL] And we don't have reference numbers so.
[CUSTOMER][NEUTRAL] Uh, you said claim number is 3597751?
[AGENT][NEUTRAL] 7754.
[CUSTOMER][NEUTRAL] 7754. OK. So I can take your name and the date as reference number.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, sure. Thank you so much for that information. Have a nice day.
[AGENT][POSITIVE] Thank you for calling APO. Bye bye.