AccountId: 011433970860
ContactId: fe1e14a2-7c37-4701-b31b-fed07f2f7bed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1108400 ms
Total Talk Time (AGENT): 201552 ms
Total Talk Time (CUSTOMER): 275559 ms
Interruptions: 6
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/fe1e14a2-7c37-4701-b31b-fed07f2f7bed_20250409T19:57_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], my name is [PII] calling from the Pros office to check on the current status.
[AGENT][NEUTRAL] Of course, I can help you with claim status today. Do you have the policy number?
[CUSTOMER][POSITIVE] Yes, I do have it.
[CUSTOMER][NEUTRAL] Can I go ahead and provide you?
[AGENT][NEUTRAL] OK. Can you
[AGENT][NEUTRAL] Oh, yes, ma'am. You can go ahead. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it is 021.
[CUSTOMER][NEUTRAL] 001.
[CUSTOMER][NEUTRAL] 52
[CUSTOMER][NEUTRAL] M as in Mike, L as in Lima, number 8.
[AGENT][POSITIVE] OK, perfect. Thank you. And then.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII], what's a good callback number in case our call gets dropped?
[CUSTOMER][NEUTRAL] OK, my callback number is [PII] and this one is a direct line to my extension.
[AGENT][NEUTRAL] OK. Yes. Uh, do you have an extension?
[CUSTOMER][NEUTRAL] No, no extension.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And then, what is the patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, perfect. Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And then for claim status, do you have?
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Do you have a date of service by chance and a charge amount?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, just a minute please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the date of service is [PII] and the total charges is $696.72.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] you want to.
[CUSTOMER][NEUTRAL] But it's just.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Yeah sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][POSITIVE] Thank you very much.
[CUSTOMER][NEUTRAL] What I.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] To both of us.
[AGENT][NEUTRAL] OK. [PII], do you mind if I put you on a brief hold while I look into your policy?
[CUSTOMER][NEUTRAL] Yes, go, go ahead.
[AGENT][POSITIVE] OK. OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 48
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 39
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 348-3987.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 348.
[AGENT][NEUTRAL] 387
[AGENT][POSITIVE] Hey, thank you for holding. Just one minute longer, OK? Sorry.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] OK. It's OK, go ahead.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, 34.
[AGENT][NEUTRAL] 8
[AGENT][NEUTRAL] 3987.
[AGENT][NEUTRAL] 34
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I don't know.
[AGENT][NEUTRAL] Hey sorry what provider's office are you calling from?
[CUSTOMER][NEUTRAL] It is Advent Health Medical Group.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Is there any cream on file?
[AGENT][NEUTRAL] I'm just not seeing that charge amount for.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] That data service which is 4:30 2024.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK, one moment. Let me tell you when they have submitted it. Actually, even I don't have any with me, but this one is a crossover claim. The primary insurance was UHC, and they have partially paid and processed the claim towards deductible, and then it was crossed over to American plan.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment, let me check whether I have any.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So there is no claim on file from your side, right?
[AGENT][NEUTRAL] Sorry, what was that?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK, this claim was submit. OK, this claim was submitted on [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] can
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Ja
[CUSTOMER][NEUTRAL] Is there any?
[AGENT][NEUTRAL] Um, I'm not seeing any files.
[CUSTOMER][NEUTRAL] Um, it's OK. Uh, could you please tell me the effective date of this member?
[AGENT][NEUTRAL] In May.
[AGENT][NEUTRAL] Yes, ma'am. So the policy effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and did the termination date, is it still active?
[AGENT][NEUTRAL] It is still active, yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, [PII] and the policy is still active, am I right? Can I get the claim timely limit?
[AGENT][NEUTRAL] 00, sorry.
[AGENT][NEUTRAL] No, the policy has lapsed. I can let you know that date. Just one second.
[AGENT][NEUTRAL] So the policy lapsed on [PII].
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Um, can you, do you have the procedures?
[CUSTOMER][NEUTRAL] Uh, OK. The patient was asking for the date of birth.
[CUSTOMER][NEUTRAL] What was that?
[AGENT][NEUTRAL] Do you have the procedure codes by chance?
[CUSTOMER][NEUTRAL] You have a procedure
[CUSTOMER][NEUTRAL] Mhm, yeah, yeah.
[AGENT][NEUTRAL] OK, that would help. Um, what are those procedure codes?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. It is 99214. It's 25 modifier and then 20611 with RT modifier and J 3301 modifier.
[CUSTOMER][NEUTRAL] I mean, sorry, CBD.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that claim is not on file.
[AGENT][NEUTRAL] As of right now. Mhm.
[CUSTOMER][NEUTRAL] OK, uh, can I get the time timelyfiing limit?
[AGENT][NEUTRAL] Sorry, what was that?
[CUSTOMER][NEUTRAL] Claim timely filing limit.
[AGENT][NEUTRAL] There is no filing limit.
[CUSTOMER][NEUTRAL] There is no filing limit?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, there's no filing limit to submit a claim.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can I get the mailing address, please?
[AGENT][NEUTRAL] Yes, let's see here.
[AGENT][NEUTRAL] The mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] OK, now I just found that the address we have sent to is incorrect. You said the [PII], right?
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[CUSTOMER][NEUTRAL] And we have submitted to [PII].
[AGENT][NEUTRAL] Oh no. OK, so when you submit the, the EOB make sure on the front of that letter to put APL claims.
[CUSTOMER][NEUTRAL] Would you.
[CUSTOMER][NEUTRAL] H.
[CUSTOMER][NEUTRAL] OK, what was that again? AP on the claim, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, APL.
[AGENT][NEUTRAL] Space claims.
[AGENT][NEUTRAL] That way it goes to the claims department.
[CUSTOMER][NEUTRAL] To the claims department. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a minute.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I'll take get the fair ID [PII].
[AGENT][NEUTRAL] The payer ID?
[CUSTOMER][NEUTRAL] Mhm to send the electronic claim?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] It is 60.
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK. Can I get the reference please?
[AGENT][NEUTRAL] Is there, is there anything else?
[AGENT][NEUTRAL] Yes, uh, the, the reference number is my first name.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Which is [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] E [PII]
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] 6.
[AGENT][NEUTRAL] And last initial [PII] and today's date.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] All right. Is there any, you're welcome. Is there anything?