AccountId: 011433970860
ContactId: 0bed49ed-e808-498a-88f5-f8e762ccb2f9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 472529 ms
Total Talk Time (AGENT): 134688 ms
Total Talk Time (CUSTOMER): 253653 ms
Interruptions: 6
Overall Sentiment: AGENT=0.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/0bed49ed-e808-498a-88f5-f8e762ccb2f9_20250425T17:28_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Thank you for calling.
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office to check on your claim status. How are you doing today?
[AGENT][POSITIVE] I'm doing good. How about you?
[CUSTOMER][POSITIVE] Yeah, I'm doing good thank you for asking.
[AGENT][NEUTRAL] You're welcome and may I please have a callback number?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, policy number is D as in Delta 432.
[CUSTOMER][NEUTRAL] 22952
[AGENT][NEUTRAL] OK, the the number is not our policy numbers. Ours start with the 01 or 02.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] OK, thank you for that.
[AGENT][NEUTRAL] May I have the patient's name, please?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, sure. The patient's name is?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, could you spell that for me, please?
[CUSTOMER][NEUTRAL] Uh, sure. Uh, [PII].
[CUSTOMER][NEUTRAL] And last name is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you. Yeah.
[AGENT][NEUTRAL] May I have the patient's date of birth, please?
[CUSTOMER][NEUTRAL] Sure. Uh my date of birth is [PII].
[AGENT][NEUTRAL] OK, I did pull that member up.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And may I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure. And the data services.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the charge amount is $343.25.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um, before that, uh, may I know your name, please?
[AGENT][NEUTRAL] Yes, it is [PII]. Would you like for me to spell that for you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Would you like for me to spell that for you?
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] It is spelled [PII]
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Alright. OK.
[AGENT][NEUTRAL] Last initial of [PII] and today's date will be used as the call reference.
[CUSTOMER][POSITIVE] Oh, thank you for that.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And I did pull that information up for you and it does show that we do have that claim on file for that claim, we received it on 2-19-25.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But that claim, you would have to, let me see, for the claim, the claim number is 356.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 5310.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] And it does show that we processed and made a payment of $100.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] And that claim number is I'm not sure if I do just give it to you 356-531-0.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And it was processed on 220 of 25.
[CUSTOMER][NEUTRAL] 220. OK. Um thank you for that. Uh, I, I just saw that, uh, two CPT codes were denied. Uh, may I know the denial reason?
[AGENT][NEGATIVE] It is shown that they denied that the maximum per calendar day max had been met once that $100 was paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, after the $100 was paid, the maximum amount was, uh, got, uh, met, correct?
[AGENT][NEUTRAL] Yes, the maximum amount was $100 that we could pay out for this claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, hereafter, uh, uh, don't, uh, didn't make any payment for the, this, this CPT code, correct?
[AGENT][NEUTRAL] For which CPT code?
[CUSTOMER][NEUTRAL] Um, uh, CPT code, uh, 82962 and
[CUSTOMER][NEUTRAL] And 93,000. Both CPT codes uh have a balance.
[AGENT][NEGATIVE] Yes, and that those two CPT codes showed that it denied the maximum amount had been met.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK. Uh, hereafter insurance you didn't pay that, correct?
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] I'm sorry, could you repeat that?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, hereafter, uh, uh, hereafter, uh, they didn't, uh, uh, pay, they didn't, uh, pay any amount for that, for this claim, correct?
[AGENT][NEUTRAL] We paid a total of $100 for this claim.
[CUSTOMER][NEUTRAL] Oh yes. Uh, you paid $100 for this time. Uh, here after, uh after $100 paid, the maximum benefits was met. Uh, so, uh, after that, uh, you don't, uh, in future, you're going to pay any amount or uh it's uh all over?
[AGENT][NEUTRAL] That's the maximum amount that we will pay out for that claim.
[CUSTOMER][NEUTRAL] Oh, OK. Thank you for that. Uh, can we bill the patient for that, for the remaining amount?
[AGENT][NEUTRAL] That is the provider's discretion.
[CUSTOMER][NEUTRAL] Uh sorry?
[AGENT][NEUTRAL] That is the provider's discretion.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, providers.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] It's the provider's choice if they want to submit the bill to the insured.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK. Uh.
[CUSTOMER][NEUTRAL] Uh, no, thank you for that. Uh, do you suggest to bill the patient or?
[AGENT][NEUTRAL] I can't advise on how to submit or bill.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 00, OK.
[CUSTOMER][NEUTRAL] Uh, providers only, uh, will the patient, correct?
[AGENT][NEUTRAL] It's the provider's choice. I can't advise on how to bill.
[CUSTOMER][NEUTRAL] Oh, OK. Thank you for that. Um, may I know the call reference number for this claim?
[AGENT][NEUTRAL] As I previously stated, it will be first name, last initial, and today's date.
[CUSTOMER][NEUTRAL] I told, uh, yeah, sorry.
[CUSTOMER][POSITIVE] Uh, OK. Uh, thank you for that. Um, thank you for your time and assistance. Have a great day.
[AGENT][POSITIVE] You're welcome and thank you so much for calling American Public Life, [PII]. Have a great day as well.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][POSITIVE] Thank you, thank you.