AccountId: 011433970860
ContactId: 18cff1ad-dac2-4fc7-b10b-3ff31b52f566
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 318369 ms
Total Talk Time (AGENT): 96435 ms
Total Talk Time (CUSTOMER): 97601 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/18cff1ad-dac2-4fc7-b10b-3ff31b52f566_20250502T14:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII]. I'm [PII] here from the provider's office for claim status.
[AGENT][POSITIVE] Alright, [PII], I'm happy to check on a claim for you. Do we have a policy number?
[CUSTOMER][NEUTRAL] Yes, I do. It's gonna be 02449754.
[AGENT][POSITIVE] All right, thank you for that. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name.
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and then date of service?
[CUSTOMER][NEUTRAL] [PII] for $807 even.
[CUSTOMER][NEUTRAL] I just need some specific clarification on the client how it was processed.
[AGENT][NEUTRAL] And data service was [PII].
[CUSTOMER][NEUTRAL] No, it's [PII].
[AGENT][POSITIVE] Thank you. Let's see.
[AGENT][NEUTRAL] And [PII], can you reconfirm the billed amount, please?
[CUSTOMER][NEUTRAL] Sure, total charges is $807 even.
[AGENT][NEUTRAL] Alright, so we do have a claim on file for that date of service, however, it's not showing that billed amount it's showing for 747 46. Is that the amount after the primary?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, one moment, let me check, uh.
[CUSTOMER][NEUTRAL] So we received an EOP for the total charges of $3,228.
[CUSTOMER][NEUTRAL] But for the client which we are inquiring about it's only for $807 even.
[CUSTOMER][NEUTRAL] And one moment please let me calculate it.
[CUSTOMER][NEUTRAL] Yeah, I just have the claim number. Can you please verify with by any chance?
[AGENT][NEUTRAL] Does it end in 554 9?
[CUSTOMER][POSITIVE] Yeah, that's perfect.
[AGENT][NEUTRAL] OK. So this claim did send a benefit payment. It looks like in the amount of $105.46.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, I just want to know about the code 99204.
[AGENT][NEUTRAL] OK, so that portion of the claim, the denial for that is that office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] Aren't covered under the member's policy, so it's responsible by the number correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry, what was that again, [PII]?
[CUSTOMER][NEUTRAL] So it's responsible by the number, correct.
[AGENT][NEUTRAL] We're not able to advise on the patient responsibility that would be up to the facility or provider.
[CUSTOMER][NEUTRAL] All right. Thank you. Could you please send a copy of your be that reflects the patient responsibility?
[AGENT][NEUTRAL] Where would you like the CO be sent?
[CUSTOMER][NEUTRAL] Sorry, what are you asking about?
[AGENT][NEUTRAL] Are you requesting a copy of the explanation of benefits?
[CUSTOMER][NEUTRAL] Yes, correct. Oh, that needs to reflect the patient responsibility since we received the UOP without patient responsibility.
[AGENT][NEUTRAL] I can't send anything with patient responsibility because we don't advise on that that's up to the facility or provider.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] All right, thank you. No worries then. But the office visits aren't current under the member's policy.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Alright, thank you for letting me know. May I get the call reference number please?
[AGENT][NEUTRAL] Absolutely, that would be my name with my last initial than today's date. My name is [PII], that's [PII] Last initial is [PII].
[CUSTOMER][POSITIVE] Thank you, sir. Have a good day. Bye-bye.
[AGENT][NEUTRAL] You too, bye bye.