AccountId: 011433970860
ContactId: 0e1bd8d4-00bd-4745-bd7d-a86508127f9e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 360230 ms
Total Talk Time (AGENT): 144371 ms
Total Talk Time (CUSTOMER): 141306 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/0e1bd8d4-00bd-4745-bd7d-a86508127f9e_20250107T14:34_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office to check on claim status.
[AGENT][POSITIVE] AJ, that is much better. I'm, I answered the call earlier and
[AGENT][POSITIVE] Couldn't hear you at all, so this is much better, and it would be my pleasure to help you with claim status. What is a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Policy number is 02319431.
[AGENT][NEUTRAL] Thank you, [PII] and the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][POSITIVE] All right, thank you, and I understand you're needing claim status and it would be my pleasure to assist you with claim status. Do you have a claim number or date of service?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] And what is the bill amount?
[CUSTOMER][NEUTRAL] $5,451 even.
[AGENT][NEUTRAL] All right, thank you. And what is the facility name, please?
[CUSTOMER][NEUTRAL] facility name is Southeast Georgia, anesthesia.
[AGENT][NEUTRAL] Thank you. And does, what is the modifier?
[CUSTOMER][NEUTRAL] The C modifier is QX and P2.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Make sure I've got the correct name.
[CUSTOMER][NEUTRAL] And there are.
[CUSTOMER][NEUTRAL] Yeah. So there are 2 claims for the same date of service bill amount for two different doctors. Do you need the doctor name?
[AGENT][NEUTRAL] Uh, no, just the tax ID number.
[CUSTOMER][NEUTRAL] OK. Tax ID is [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so I'm showing that we did receive this claim.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] On 8-10-2024.
[AGENT][NEUTRAL] And was processed, I'm sorry, I apologize. We received it on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And it was denied as this.
[AGENT][NEUTRAL] Policy does not provide a benefit for anesthesia services, so it's non-covered.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] So the whole bill amount 5,451 is patient's responsibility.
[AGENT][NEUTRAL] Uh, we don't determine patient responsibility. That would be up to the major medical and the provider. We're not major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And do you have the major medical insurance information for this patient?
[AGENT][POSITIVE] I can get that for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see. Well.
[CUSTOMER][NEUTRAL] right.
[AGENT][NEUTRAL] Let me see if I can
[AGENT][NEUTRAL] Locate that for you, bear with me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] My little
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] AJ, this policy is no longer active. I do not have their primary insurance information.
[CUSTOMER][NEUTRAL] OK. No problem. May I know the call reference number?
[AGENT][NEUTRAL] Call reference number is my name and today's date, and I spell my name [PII]. And did you need that claim number, [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, yeah, what is the claim number?
[AGENT][NEUTRAL] Claim number is 3484271.
[CUSTOMER][NEUTRAL] How
[CUSTOMER][NEUTRAL] And could, is the doctor, let's see.
[CUSTOMER][NEUTRAL] The doctor, is it [PII]?
[CUSTOMER][NEUTRAL] Or huge Mcguire.
[AGENT][NEUTRAL] Let me get that claim pulled up. I can tell you that.
[CUSTOMER][NEUTRAL] Really
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] OK. And do you see the claim, a claim for a huge Mc wire for the same data storage on everything same?
[AGENT][NEUTRAL] What's that modified? Is that the QK?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, let's see, modifier QK and P2.
[AGENT][NEUTRAL] OK, yeah, we have that claim on file received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] With
[AGENT][NEGATIVE] Denied for the same reason.
[CUSTOMER][NEUTRAL] And the phone number?
[AGENT][NEUTRAL] I'm sorry, can you repeat that?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And the claim number?
[AGENT][NEUTRAL] That claim number is 3484266.
[CUSTOMER][POSITIVE] Got it. Thank you so much for your assistance. You have a great day. Bye-bye.
[AGENT][POSITIVE] It's been my pleasure to assist you with that claim status and thank you for calling APL. AJ, it was a pleasure to assist you. You have a wonderful day.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You too.