AccountId: 011433970860
ContactId: 186f3942-cb71-4ca1-8f48-245989c3ea5c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 512840 ms
Total Talk Time (AGENT): 182860 ms
Total Talk Time (CUSTOMER): 103778 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/186f3942-cb71-4ca1-8f48-245989c3ea5c_20250415T19:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEGATIVE] Uh, yes, I'm calling from our provider's office, and I received a denial, um, stating I claim denied as a duplicate. Um, I don't ever, um, ever received anything prior to that.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, all right. I can help you with the claim, ma'am. Can you please give me your name and your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and my callback number is [PII].
[AGENT][NEUTRAL] OK, Ms. [PII]. And you said that you received an EOB back saying that you had a claim that was duplicated and you don't remember getting the first initial EOB. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Right, I don't show, yeah, I don't show that anything's ever been posted prior to that to the account.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right. um, Miss [PII], can I please get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK, the policy number is 02521722. Patient's first name is [PII] Last name is [PII] [PII] Date of birth is [PII].
[AGENT][POSITIVE] Thank you, ma'am. Alright, let me look that policy up real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] OK, the date of service is gonna be [PII]. Total charges was $416.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Um, remaining balance is $21.84.
[AGENT][NEUTRAL] OK, thank you, and then can I please get the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] It is NUSC physicians.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, Ms. [PII], while I look this claim up and I will be right back, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi, Ms. [PII], this is [PII]. I've got the original EOB pulled up for the claim. The original EOB number is 356-713-7.
[AGENT][NEGATIVE] It was denied because it's a non-covered service under the patient's plan.
[AGENT][NEUTRAL] And if you can give me your fax number, I'll fax this original EOB over to you.
[CUSTOMER][NEUTRAL] OK, my fax number is [PII].
[CUSTOMER][NEUTRAL] [PII] so he doesn't have any like outpatient um office visits uh um coverage under his plan.
[AGENT][NEUTRAL] Uh, let me check and see about that. I do know that the procedure that was denied was 99215.
[CUSTOMER][NEUTRAL] Yeah, that's for uh office visit.
[AGENT][NEUTRAL] Yes, ma'am. No, ma'am. Office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] What kind of policy does he have? Is it like just hospital only or is it for certain services?
[AGENT][NEUTRAL] It is a um.
[AGENT][NEUTRAL] It's a supplemental insurance policy, and this is just to verify the benefits it's not a guarantee of payment. He, it helps with deductible, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So if he goes inpatient, he has a benefit amount of $1000 and if he goes outpatient, he has a benefit amount of $200 per calendar day for covered services, um, although the treatment will be covered in the office, the office visit itself is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So anything other than an office visit is covered, just not the actual office visit.
[AGENT][NEUTRAL] Well, it goes by facility so.
[CUSTOMER][NEUTRAL] Like if he has like a
[AGENT][NEUTRAL] It, it works by facility. So if he goes to an ER urgent care center, MRI imaging center or an ambulatory center, then those services are covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, yeah, if you can just fax me that and I'll scan it in and have it in his in her chart.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes ma'am, yes ma'am. I'm going to um put you on a quick hold, Miss [PII] again so I can get this fax ready and I'll be right back and let you know that I have it sent, OK?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Uh, OK, it's gonna be a brief hold.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I'm, I'm on hold, but I'm sending something.
[AGENT][NEGATIVE] I don't have anything
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on.
[AGENT][NEUTRAL] OK, Ms. [PII], I have that fax on its way to you now, ma'am.
[CUSTOMER][NEUTRAL] OK, is there a reference number for our call?
[AGENT][NEUTRAL] Yes, you can use my name and um today's date. My name is [PII], it's [PII]
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're very welcome. You have a wonderful week and thank you for calling APL.
[CUSTOMER][POSITIVE] Uh-huh, you too. Thank you.
[AGENT][NEUTRAL] Bye-bye, ma'am.
[CUSTOMER][NEUTRAL] Co