AccountId: 011433970860
ContactId: 024de8f9-1d1f-468d-9452-7c3d8be3e1df
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 378519 ms
Total Talk Time (AGENT): 115586 ms
Total Talk Time (CUSTOMER): 118342 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/024de8f9-1d1f-468d-9452-7c3d8be3e1df_20250313T21:14_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APO. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII]. I'm calling from provider office for claims.
[AGENT][NEUTRAL] OK, sure, I can assist you with claims Ms. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh yes, it is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you're calling from which facility from my location?
[CUSTOMER][NEUTRAL] Uh, this is for the provider bit by bit.
[AGENT][NEUTRAL] I'm sorry, you said bit by bit.
[CUSTOMER][NEUTRAL] Yes, B B I T by bit.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes it is.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes, it is 0245831 M as in Mary, L as in Lima, S as in Sierra.
[CUSTOMER][NEUTRAL] No, not as, it is number 8, sorry.
[AGENT][NEUTRAL] Yeah, OK, it's fine. OK, thank you, one moment.
[AGENT][NEUTRAL] One minute.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, bear with me just a second, waiting on my system.
[AGENT][NEUTRAL] All right. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient is
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, um, can you repeat that number because it's not pulling anything up. It's still saying that it's nothing in the system with that number.
[CUSTOMER][NEUTRAL] 0
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, it is 02458531 M [PII] number 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I was missing that 5, thank you.
[AGENT][NEUTRAL] 15. OK, that's it. OK. All right. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service is [PII]. Bill amount is $85.
[AGENT][NEUTRAL] OK, [PII] for $85.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me see if I can find this claim. For future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] And bear with me, let me pull this ELB. OK, one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I'm still waiting on the system OK.
[AGENT][NEUTRAL] Looks like it was processed on [PII].
[AGENT][NEGATIVE] And it was denied. The reason for the denial is that kineology, speech, or occupational therapy are not covered under this patient's plan.
[CUSTOMER][NEUTRAL] Under this policy, it, uh, OK. Actually, what, what is happening here for other date of service like, uh, if I talk about the date of service, [PII], we receive payment from the insurance.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is that [PII]?
[CUSTOMER][NEUTRAL] No, yeah, [PII].
[AGENT][NEUTRAL] OK. Was it just um physical therapy or was it occupational therapy or speech or kindnessology because we cover physical but we don't cover um the ones that I just mentioned.
[CUSTOMER][NEUTRAL] Oh, I got it. What happened here? Oh, just a moment. Charge amount is similar and it seems like I think service is different. Just a moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, the procedure code is different. Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Look
[CUSTOMER][NEUTRAL] 97,110 and uh for our date of service I have.
[CUSTOMER][NEUTRAL] [PII]. Yes, actually, you are right that services are different. The charge amount is the same.
[AGENT][NEUTRAL] Mhm. Yeah.
[CUSTOMER][NEUTRAL] Uh 141.
[CUSTOMER][POSITIVE] OK, so thank you so much for this clarification and uh that's all. Mhm bye bye. Have a nice day.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] Yes, ma'am. Thank you for calling APM mhm bye bye.
[CUSTOMER][POSITIVE] Yeah thank you bye.
[AGENT][NEUTRAL] Yeah.