AccountId: 011433970860
ContactId: 14613c86-106f-4a6d-96fb-c1722757e426
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 362519 ms
Total Talk Time (AGENT): 96396 ms
Total Talk Time (CUSTOMER): 173245 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/14613c86-106f-4a6d-96fb-c1722757e426_20250313T19:45_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Good day. My name is [PII]. Last name initial is [PII] I am calling from Laboratory Corporation of America. For training and quality purposes. This line will be recorded, and I am calling regarding the status of the claims that we have submitted for two of our mutual patients. Can you please help me with this?
[AGENT][NEUTRAL] Sure. Could I get the policy number you're calling on?
[CUSTOMER][NEUTRAL] Yeah, sure. For the first member, the policy number is 229-917-6.
[AGENT][NEUTRAL] The patient's name and date of birth?
[CUSTOMER][NEUTRAL] Name is [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] Thank you and you said status, what is the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] The total bill?
[CUSTOMER][NEUTRAL] Total bill amount is $332.85.
[AGENT][NEUTRAL] Is this for lab charges?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I show the claim has been received. The claim.
[AGENT][NEUTRAL] Um, it looks like we made a payment of $55.15.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh for this one I have checked here that there is a denied CPT code that was not paid. May I know what is the denial reason for this CPT code?
[AGENT][NEUTRAL] Uh, what is the CPT code?
[CUSTOMER][NEUTRAL] One moment. Let me get that for you so I can provide it.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] So the uh delight CPT code is 36415.
[AGENT][NEUTRAL] OK, that one was denied stating it was not covered by the primary.
[CUSTOMER][NEUTRAL] Alright, I will take note of this one and is there any patient responsibility on your end by any chance?
[AGENT][NEUTRAL] We do not determine patient responsibility.
[CUSTOMER][NEUTRAL] Alright, no worries, I will take note of this one and for us to proceed to the next number, may I have the um call reference number?
[AGENT][NEUTRAL] The call reference number will be the same for both and that is my name, K E S H I A and today's date.
[CUSTOMER][NEUTRAL] All right. It is K E S H I A, then today's date. Is that correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Alright, thank you, can we now proceed to the next member?
[AGENT][NEUTRAL] Yes. What is the next policy number?
[CUSTOMER][NEUTRAL] Policy number is 02455589.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Name is [PII].
[AGENT][NEUTRAL] OK, and what is the data service?
[CUSTOMER][NEUTRAL] Date of service is [PII]. And by the way, the date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, thank you. I do apologize for that.
[AGENT][NEUTRAL] OK. And what is, um,
[AGENT][NEUTRAL] Uh, the total bill again?
[CUSTOMER][NEUTRAL] The total bill amount is $696.15.
[AGENT][NEUTRAL] OK, I do show that this claim was received, the claim was denied, uh, the incorrect EOB was sent.
[AGENT][NEUTRAL] With the claim we need the matching EOB.
[CUSTOMER][NEUTRAL] From the primary insurance, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right, thank you. I will take note of this information and by any chance do you have the information regarding the primary insurance of this member?
[AGENT][NEUTRAL] Hold one moment please.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][NEUTRAL] Uh, looks like, uh, the patient had AvMed.
[CUSTOMER][NEUTRAL] Do you have the ID number?
[AGENT][NEUTRAL] No, ma'am. You would have to get that information from the, uh, from the member.
[CUSTOMER][NEUTRAL] All right, let's see.
[CUSTOMER][NEUTRAL] Can you spell the name of the insurance, sorry?
[AGENT][NEUTRAL] A V M E D.
[CUSTOMER][POSITIVE] All right, thank you, I will take note of this one.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] This is the
[CUSTOMER][NEUTRAL] This is the primary, right? And for documentation purposes, may I have your last name initial?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Alright, thank you [PII] and I think that would be all. I appreciate you for taking the time to answer my call and helping me with this matter again this is [PII] and have a great day. Bye for now. Thank you.
[AGENT][POSITIVE] You're well.
[AGENT][POSITIVE] You have a wonderful day, [PII]. Thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright thank you bye bye.