AccountId: 011433970860
ContactId: 01fb748c-b84e-462b-a09c-ccb58be5abe9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 444640 ms
Total Talk Time (AGENT): 150072 ms
Total Talk Time (CUSTOMER): 165273 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/01fb748c-b84e-462b-a09c-ccb58be5abe9_20250613T16:29_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Yes, uh, this is [PII]. I'm calling from the um provider's office. How are you?
[AGENT][NEUTRAL] OK. And how may I assist you today, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, I'm calling regarding to the current status that we received and
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I see that these two line item has, uh, it wasn't paid, so I just wanted to know why.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me know what you need.
[AGENT][NEUTRAL] OK. May I have the spelling of your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, uh, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh yes, it is.
[CUSTOMER][NEUTRAL] 025
[CUSTOMER][NEUTRAL] 18092
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What's the name of the facility you're calling from, please?
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] It's called the the root.
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, I know who.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Or it's also known as uh [PII] mhm.
[AGENT][NEUTRAL] And then, OK.
[AGENT][NEUTRAL] And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] There you go
[CUSTOMER][NEUTRAL] Uh official's name is, uh, first name is [PII]
[CUSTOMER][NEUTRAL] Last name is [PII]
[CUSTOMER][NEUTRAL] His date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you. Alright, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes, it's uh [PII].
[AGENT][NEUTRAL] OK, how much is the total charge?
[CUSTOMER][NEUTRAL] Uh, let's see here hold on just a second.
[CUSTOMER][NEUTRAL] It's supposed to be let's see where is it.
[CUSTOMER][NEUTRAL] Sorry, hang on just a second.
[CUSTOMER][NEUTRAL] I just
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can
[CUSTOMER][NEUTRAL] So I, I don't have a total of the claim, but I have 3 line items.
[AGENT][NEUTRAL] What is the procedure called?
[CUSTOMER][NEUTRAL] It's more likely that it's uh
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The procedure code is 99204.
[AGENT][NEUTRAL] 04. OK.
[CUSTOMER][NEUTRAL] And uh it looks.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Looks like
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $3369.06.
[CUSTOMER][NEUTRAL] A total?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment, I'm waiting on the AB to pull up, OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So it looks like we have two claims one claim is for 35906.
[CUSTOMER][NEUTRAL] And the other single claim is $10 the draw fee, 36415.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're waiting on the system. One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, let me see what we received because it's saying that um
[CUSTOMER][NEUTRAL] It's so red.
[AGENT][NEUTRAL] We need additional information so let me check and see what happens.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Oh, OK. So this is the first senial. Let me go ahead and pull the most recent one. It looks like we processed this twice. OK, one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, so it looks like the last time we processed the claim was on [PII] and we send a benefit amount of $100 to the provider.
[CUSTOMER][POSITIVE] Yes, we got that payment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I'm asking for the other two line item 93,000 and 36415.
[AGENT][NEUTRAL] OK, so the 93,000 is on the same claim on the 93 36415 is in a separate claim. So let me go ahead and give you the denial for the 93,000, which is that the maximum benefit payable for the date of service has been met, that is the denial for the 93,000.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] Um, for the.
[AGENT][NEUTRAL] Other codes.
[CUSTOMER][NEUTRAL] So, so that would be the patient responsibility, right?
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't have any contractual involvement on the remaining of the claim. This is just a limited policy.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] So if it's not, then this should be responsible for that.
[AGENT][NEUTRAL] Yeah, this is not a major medical. Yeah, we don't know if they have any other accounts out there or policies out there.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] OK, and for the code 36415, Benny puncture is not covered under this policy. So that one was denied stating that it's just not covered under the policy.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][MIXED] So, it's not a cough, but so it's OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] No, appreciate that.
[AGENT][POSITIVE] OK, well thank you for calling APL. You're welcome. Have a good afternoon. Bye-bye.
[CUSTOMER][POSITIVE] Thank you very much. Bye-bye.
[CUSTOMER][POSITIVE] OK thank you.
[AGENT][POSITIVE] You're welcome.