AccountId: 011433970860
ContactId: 1226883b-43db-406d-b3b7-048c2138e722
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 612710 ms
Total Talk Time (AGENT): 192147 ms
Total Talk Time (CUSTOMER): 130781 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/1226883b-43db-406d-b3b7-048c2138e722_20250514T17:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on claim status. May I know your name? I didn't get your name.
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] OK, [PII], can you help me claim status for my patient, [PII]?
[AGENT][NEUTRAL] Yes, I can help you with claim status [PII] can you please give me the patient's name, date of birth and policy number?
[CUSTOMER][NEUTRAL] The policy number I have is 02277598.
[CUSTOMER][NEUTRAL] And the patient name is [PII], [PII].
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] [PII] for the bill amount is $190.
[AGENT][NEUTRAL] OK. And then may I also have the name of the facility or the physician?
[CUSTOMER][NEUTRAL] The name of the facility is Morton Ranch Ms Industry. The provider name is [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim, [PII] and I'll be right back with you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much for holding for me [PII] I have the claim information for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The, the claim number is
[CUSTOMER][NEUTRAL] What's the time for the [PII].
[AGENT][NEUTRAL] The claim number is 355.
[AGENT][NEUTRAL] 243 2.
[AGENT][NEUTRAL] The claim was paid $167.
[AGENT][NEUTRAL] With check number 2023128.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] The claim was received on.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEUTRAL] The check did clear the bank on [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] You already received the payment. You already received the payment. I just need a specific procedure code status in this claim. The procedure codes like uh 1206 and 0274.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me look at that again.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so we have some remarks on the claim. Um, one of them is
[AGENT][NEUTRAL] The
[CUSTOMER][NEUTRAL] Go ahead, go ahead. Sorry.
[AGENT][NEUTRAL] The procedure or services are in the schedule are ineligible because this policy does not provide benefits for procedures or services not listed in the schedule for the policy the insured's policy.
[AGENT][NEUTRAL] Um, also limited to one bite wing or X-ray procedure every 12 months, so it was denied because you get one every 12 months.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 02740274 was unite for frequency.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] And then we also have this benefit.
[CUSTOMER][NEUTRAL] OK, you can see limit is 1 per 12.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, sorry, sorry for interruption. On for 12 months or 24 months?
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] OK, and then this benefit has been applied to your calendar year deductible, so part of that was applied to the deductible.
[CUSTOMER][NEUTRAL] OK. Can you say the previous history for the 0274?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] Uh, the previous history on [PII], that procedure was done.
[AGENT][NEUTRAL] And also on
[CUSTOMER][NEUTRAL] And a different provider?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That was uh 112 months, right?
[AGENT][NEUTRAL] Then I'll
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. What about the 0, 1206 is that denied for age limit or not covered service?
[AGENT][NEUTRAL] And what was the, the um procedure code again?
[CUSTOMER][NEUTRAL] 1206
[AGENT][NEUTRAL] OK, let me look on the EOB.
[AGENT][NEUTRAL] It's a non-covered service.
[CUSTOMER][NEUTRAL] What is the patient that one free amount for that code?
[AGENT][NEUTRAL] We do not give patient responsibility that's determined by the provider.
[CUSTOMER][NEUTRAL] OK, but our record shows this is a covered service, that's why I'm asking.
[CUSTOMER][NEUTRAL] You're sure it's really not covered under the patient's plan?
[AGENT][NEUTRAL] We still do not
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient, may I know the plan name of the patient?
[AGENT][NEUTRAL] Yes, let me look at that.
[AGENT][NEUTRAL] It's uh D4 F F S U T B A through APL.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The group name?
[AGENT][NEUTRAL] Group name is Universal Trucking United Petroleum.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 0274 was denied for that reason, OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] The 0220, that was denied for what reason?
[AGENT][NEUTRAL] 0230.
[CUSTOMER][NEUTRAL] OK, that is applied towards to totally towards deduct.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] And what was the procedure code again?
[CUSTOMER][NEUTRAL] 0220.
[AGENT][NEUTRAL] 68 let me see what that says.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, that was applied towards the calendar year deductible.
[CUSTOMER][NEUTRAL] OK, then.
[CUSTOMER][POSITIVE] Thanks, thank you for actually. What will be the call reference number?
[AGENT][NEUTRAL] Yes, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] OK, then thanks. Thank you. Bye.
[AGENT][POSITIVE] You're very welcome [PII] is that everything I can help you with before we go sir?
[CUSTOMER][POSITIVE] And that's all, thanks. Thanks.
[AGENT][POSITIVE] Alright well you have a wonderful day and thank you for calling APL.
[CUSTOMER][NEUTRAL] Yeah, bye.
[AGENT][NEUTRAL] Bye-bye, sir.