AccountId: 011433970860
ContactId: 160e64d7-5883-420d-a00a-eb7577cf75af
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 463480 ms
Total Talk Time (AGENT): 129823 ms
Total Talk Time (CUSTOMER): 130031 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/160e64d7-5883-420d-a00a-eb7577cf75af_20250220T15:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] and uh initial of my last name is [PII], and I'm calling from Forder's office and looking for a claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Can I please get your callback number?
[CUSTOMER][NEUTRAL] Uh yeah, sure, one moment.
[CUSTOMER][NEUTRAL] Uh, it would be [PII].
[AGENT][NEUTRAL] Thank you sir and then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Uh, patient's name is [PII], and uh date of birth is [PII]. And the member ID is 021562229.
[AGENT][NEUTRAL] OK, let me look that policy up real quick.
[AGENT][NEUTRAL] OK and then what is the date of service?
[CUSTOMER][NEUTRAL] The service is [PII] and the charge amount is $215 even.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, so you mean the patient responsibility, the, uh, primary left or?
[AGENT][NEUTRAL] The balance left after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] The primary insurance paid, right?
[AGENT][NEUTRAL] Right after they paid, what's the balance?
[CUSTOMER][NEUTRAL] Uh, yes, let me check one moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, the primary insurance.
[CUSTOMER][NEUTRAL] Pa, uh nothing but uh they process the claim in deductible. That is the patient responsibility. And uh the amount they processed in deductible is $84.60.
[AGENT][NEUTRAL] OK, thank you. And then one last question, can you please give me the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yeah, it is Walker Chiropractic.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim for you, [PII], and I'll be right back.
[CUSTOMER][POSITIVE] OK, sure. Take your time.
[AGENT][POSITIVE] Thank you sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Oops, that's wrong.
[AGENT][NEUTRAL] 2:15 this must be right here.
[AGENT][NEUTRAL] 55252.
[AGENT][NEUTRAL] Yeah, that's it.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I've got your results of the search for the claim.
[AGENT][NEUTRAL] The claim number is 3552025.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was denied because the office visits for the calendar year were maxed out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Sorry, the office visit is?
[AGENT][NEUTRAL] Yes, on this policy, the insured gets 4 office visits per year, and all 4 visits were were used, so the benefits were maxed out for the calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Only for office visit, but uh what about the uh two other procedure codes that is 98,940 and 97014.
[AGENT][NEUTRAL] It the claim was denied because the office visits for the calendar year were maxed out.
[CUSTOMER][NEUTRAL] We mixed out, right?
[AGENT][NEUTRAL] Right, the benefits were maxed out for the calendar year.
[CUSTOMER][NEUTRAL] So what?
[CUSTOMER][NEUTRAL] So what we have to do for this now?
[AGENT][NEUTRAL] Uh, I can't advise on what you should do as far as getting your insured to pay their bill. I can't advise on that.
[CUSTOMER][NEUTRAL] Well, you know
[CUSTOMER][NEUTRAL] Uh, OK. Can you give me the, uh, 4 data services that uh has been paid with office uh office code?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, that's private information. I can't reveal that.
[CUSTOMER][NEUTRAL] So you don't have that information?
[AGENT][NEUTRAL] I do, but I can't give it to you because it may not be for your facility that's private information.
[CUSTOMER][NEUTRAL] OK. So the member has a total of 4 visits and it has been exceeded, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] That is why this claim got denied.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Uh, can you please tell me, uh, how many visits does he have for chiropractic?
[CUSTOMER][NEUTRAL] Besides the office?
[AGENT][NEUTRAL] It's not based on, on the type of service. It's based on the facility and they maxed out their 4 visits for the calendar year.
[CUSTOMER][NEUTRAL] OK, they only have 4 visits for this calendar year.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK. Uh thank you so much. Uh, could you please uh spell out your name?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] And what is the initial to your last name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, [PII], and uh what would be the call difference?
[AGENT][NEUTRAL] You can use my name and today's date.
[CUSTOMER][POSITIVE] OK, OK. Thank you so much for verify your kind assistance. Hope you're having a good day ahead.
[AGENT][POSITIVE] You too, [PII]. Thank you. I hope you have a blessed rest of your week. Thank you for calling APL.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][NEUTRAL] Bye-bye.