AccountId: 011433970860
ContactId: 100168e6-2242-4fcf-b47a-15f8e6c498a4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 534140 ms
Total Talk Time (AGENT): 169004 ms
Total Talk Time (CUSTOMER): 209650 ms
Interruptions: 3
Overall Sentiment: AGENT=0.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/100168e6-2242-4fcf-b47a-15f8e6c498a4_20250207T13:29_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. My name is [PII]. Last name initial [PII] [PII]. I would like to check the claim status.
[AGENT][NEUTRAL] I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. 0245.
[CUSTOMER][NEUTRAL] 5047.
[AGENT][NEUTRAL] OK, what's a good phone number in case we're disconnected?
[CUSTOMER][POSITIVE] Yeah, sure. Thank you so much. The callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's a direct line?
[AGENT][NEUTRAL] [PII] thank you one moment.
[CUSTOMER][POSITIVE] Take it on time.
[CUSTOMER][NEUTRAL] he got.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] We want to go to
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, one moment please.
[CUSTOMER][NEUTRAL] Take your own time.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you and you said you're checking claim status?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And if I can get the date of service and the total charge?
[CUSTOMER][NEUTRAL] Sure. [PII]. Total charge amount $597.98.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, you said it's [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what are the procedure codes on that claim?
[CUSTOMER][NEUTRAL] Yeah, but Zip code is [PII] followed by three consecutive zeros.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, this claim was received [PII] processed.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] For on [PII]. OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] That's the explanation of benefits was mailed on the [PII] to the address on the claim.
[AGENT][NEUTRAL] Showing that there was no
[CUSTOMER][NEGATIVE] This client got denied or paid.
[AGENT][NEUTRAL] That's what I'm fixing to give you.
[AGENT][NEUTRAL] I showed that the policy was not payable, uh, the office visit fee is not covered under the policy, and the other codes that you provided, the primary insurance paid those codes in full, and you can also, uh, check your claim status online at [PII] [PII], and any other questions?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Wait, wait. Office visits are not allowed.
[AGENT][NEUTRAL] They're not covered by the patient's policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, that is a major denial, right?
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, these all data services, all procedure codes are not office visits, right? 17110 17,000. It's not office visits. 99214 is only office visit.
[AGENT][NEGATIVE] They were denied because the primary insurance paid the er the the the charge in full.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The office visit fee is not covered by the patient's policy.
[CUSTOMER][NEUTRAL] And uh like uh 17,110, 17,000 is primary paid, right? More than secondary.
[AGENT][NEUTRAL] Yeah, according to the ELB that this office sent with the claim, that's what it states so you may wanna refer to the ELB that you all sent to us that's what it says, they paid it in full.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Wait, wait, wait.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much. I'll verify my system have the primary or not. One moment.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], can you give me your phone number again?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Why? Yeah, I have a phone callback number [PII].
[AGENT][NEUTRAL] Your phone number?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Just a few more minutes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] OK. Primary pay. Can you please tell me one more time for the complete reason, primary pay?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I can make a note.
[AGENT][NEUTRAL] I didn't understand your question.
[CUSTOMER][NEUTRAL] Primary was remaining 22 line items.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Primary paid full amount, right?
[AGENT][NEUTRAL] For the treatment codes, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] May I know the claim number you have?
[AGENT][NEUTRAL] That claim number is 3551638.
[CUSTOMER][NEUTRAL] OK. Call reference number?
[AGENT][NEUTRAL] Is my name in today's date, [PII]
[AGENT][NEUTRAL] First initial last name is [PII].
[CUSTOMER][NEUTRAL] Yeah, [PII], can you please send a copy of the OB with the complete information? We have UOB, however, it's showing only office views are not covered by the above number of policy we have only that one.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, the ELB was mailed on the [PII]. The APL explanation of benefits was mailed to this your office on the [PII], and it is now available to download online. Let me know when you're ready and I can give you the web address to download that. You'll be using the claim number provided.
[CUSTOMER][NEUTRAL] OK. Can you please provide it?
[AGENT][NEUTRAL] Secured S [PII]
[CUSTOMER][POSITIVE] Secured
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] A [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The word [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's not open yet.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Mhm, secure. [PII], right.
[CUSTOMER][POSITIVE] I like it.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, which one primary only, right? With login credentials, it's open or not?
[CUSTOMER][NEUTRAL] You don't have access to check-in portal.
[AGENT][NEUTRAL] Yeah, you'll have to create you'll have to answer the security questions so you'll need to enter the your provider's tax identification number and the patient account number that's on the claim.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] OK, you have it yet
[CUSTOMER][NEUTRAL] No, they are asking username password.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, so you'll have to create a username and a password.
[CUSTOMER][NEUTRAL] You don't have access, right? That's why I'm telling.
[AGENT][NEUTRAL] It's just asking you, you do have access but you have to create a username and password.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] In order to to get into the side.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII]. Thank you so much. Can you please provide the call reference number?
[AGENT][NEUTRAL] My name and today's date. Mhm.
[CUSTOMER][NEUTRAL] OK, 2 days.
[CUSTOMER][POSITIVE] Sorry for that. Thank you. Thank you so much. Have a great day. Bye for now.
[AGENT][POSITIVE] All right. All [PII]. Thanks for calling APL. Have a good day.