AccountId: 011433970860
ContactId: 01a8441a-205d-4878-a374-fd1f70585bdb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 577489 ms
Total Talk Time (AGENT): 133315 ms
Total Talk Time (CUSTOMER): 258097 ms
Interruptions: 12
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/01a8441a-205d-4878-a374-fd1f70585bdb_20250320T14:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on our client status.
[AGENT][NEUTRAL] I can verify claim status. G. May I have a policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] May I have the policy number?
[CUSTOMER][NEUTRAL] May I have the policy
[CUSTOMER][NEUTRAL] Yeah, before that, could you please spell out your name?
[AGENT][NEUTRAL] [PII] Last initial is [PII]
[CUSTOMER][NEUTRAL] [PII] last initial is [PII] OK.
[CUSTOMER][NEUTRAL] So, yeah, the member ID is 202,574,010.
[AGENT][NEUTRAL] May I have a good callback number for you?
[CUSTOMER][NEUTRAL] Yeah, callback number will be [PII].
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] May I have the patient's name and date of birth? Sure. The name will be [PII].
[AGENT][NEUTRAL] May I have the date of birth?
[CUSTOMER][NEUTRAL] And the date, yeah, the date of birth will be [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. May I have a date of service?
[CUSTOMER][NEUTRAL] Yeah, sure. The data service will be.
[CUSTOMER][NEUTRAL] [PII] and the total charge amount will be $723.52.
[AGENT][NEUTRAL] Thank you. For future reference, you may visit our website at [PII] to check claim status as well.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Site at [PII] is that claim status is for you.
[AGENT][NEUTRAL] One moment. And who would be the provider on this claim?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] So the provider will be urgent Care Group LLC.
[AGENT][NEUTRAL] This process under claim number 3542473 looks like a benefit amount of $75 paid to the provider on [PII].
[CUSTOMER][NEUTRAL] This process
[CUSTOMER][NEUTRAL] 35
[CUSTOMER][NEUTRAL] 42
[CUSTOMER][NEUTRAL] 473 looks like a benefit amount of.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. OK, so yeah, actually I have this client with me and for the line item 99214 it got paid $75 right? So for the remaining CPT, uh, remaining line item, it was denied, uh, for like I don't have the proper denial reason with me. So could you please explain to me what happened to the remaining codes.
[AGENT][NEUTRAL] The benefit amount only allows $75 per visit. So, so the benefit is only going to cover $75.
[CUSTOMER][NEUTRAL] The benefit amount only allows $75 per.
[CUSTOMER][NEUTRAL] So the benefit is only gonna cover $75.
[AGENT][NEUTRAL] Any remaining balance becomes patient's responsibility.
[CUSTOMER][NEUTRAL] OK, so it is maximum benefit exhausted, correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, thank you so much for that. Just a second.
[AGENT][NEUTRAL] Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, actually, I have a few more questions for this client. And can I have the like maximum bene uh is the maximum benefit exhausted is as per visits or dollars?
[AGENT][NEUTRAL] The benefit amount allows $75 per visit.
[CUSTOMER][NEUTRAL] The benefit amount allows $75.
[CUSTOMER][NEUTRAL] OK. Is it as per dollars, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, fine.
[CUSTOMER][NEUTRAL] So, can I have the uh
[CUSTOMER][NEUTRAL] Is it annual or lifetime dollars?
[AGENT][NEUTRAL] No, the benefit per calendar year will only allow $75 per visit, 5 visits per calendar year.
[CUSTOMER][NEUTRAL] No, the benefit per calendar year will only allow $75 per visit.
[CUSTOMER][NEUTRAL] Our calendar year.
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][NEUTRAL] So it is uh $75 right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. So, for an annual, it is only uh 55 visits.
[AGENT][NEUTRAL] That was the first visit.
[AGENT][NEUTRAL] The benefit only allows $75.
[CUSTOMER][NEUTRAL] We allow $75.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, how much it was net, uh,
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] You said the dollars is $75 right? So it was net fully, right? Or is there any balance for that?
[AGENT][NEUTRAL] Any remaining balance becomes patients responsibility. The benefit max will only allow $75 per visit.
[CUSTOMER][NEUTRAL] Remaining balance becomes the patient's responsibility.
[CUSTOMER][NEUTRAL] Benefit
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So how many visits is there, is that? Is it 5?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] They are allowed 5 visits per calendar year. They've only used 1.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Per calendar year only.
[CUSTOMER][NEUTRAL] OK, they have used only one.
[CUSTOMER][NEUTRAL] OK. Uh, yeah, [PII], uh, just a second. I need to verify some details now. I just placed the call on hold for a minute and I'll be back as soon as, right? OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, thank you so much, [PII], for being on the line. And so, uh, OK, for the remaining CPD it is uh full of patient responsibility, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK. OK, thank you so much for that.
[AGENT][NEUTRAL] Is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, just a second. Uh, just checking out your.
[CUSTOMER][NEUTRAL] So, uh, for what, uh, for per visit, it is 75, right? $75. OK, thank you. OK.
[AGENT][POSITIVE] Correct. Correct. That is the max benefit allowed.
[CUSTOMER][NEUTRAL] OK, can I get the call reference number for this?
[AGENT][NEUTRAL] It will be my name, which is [PII] Last initial is [PII] along with today's date.
[CUSTOMER][NEUTRAL] My name is
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII], for your assistance. Have a great day. Bye-bye for now. Take care.
[AGENT][POSITIVE] Yeah, thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][POSITIVE] Yeah, thank you for calling have a great day. Yeah, bye bye.