AccountId: 011433970860
ContactId: 1f362e5a-fbac-4cb4-af4b-8a1a775293ad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 220779 ms
Total Talk Time (AGENT): 88179 ms
Total Talk Time (CUSTOMER): 79640 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/1f362e5a-fbac-4cb4-af4b-8a1a775293ad_20250403T15:00_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APPL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I'm calling from Baptist Primary Care. I'm calling to, uh, verify the denial for a claim that, um, we have received or we have a claim and we received the denial, but the denial is not clear.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, sure. Yes, it's OK. I can assist you with that, Ms. [PII]. I can assist you with claims. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] She
[CUSTOMER][NEUTRAL] Uh, policy number is 02584203.
[AGENT][POSITIVE] Thank you. Let's see.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Um, so patient's name is [PII]. Uh, date of birth is [PII].
[AGENT][NEUTRAL] Mm, can you verify the date of birth one more time?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK. All right. And what is the date of service?
[CUSTOMER][NEUTRAL] Um, data service I have is [PII] for build amount $878.
[AGENT][NEUTRAL] Yeah. All right, let me go ahead and pull the details of that claim. One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] I'm still waiting. It's gonna be one more minute.
[CUSTOMER][POSITIVE] Sure, no problem.
[AGENT][NEUTRAL] OK. So it looks like um the office visit is not covered because it's not a cover service under the member's plan. So the 99214 was denied this office visit is not covered under the member's plan. And then um
[AGENT][NEUTRAL] There is, uh, see a couple of charges that um
[AGENT][NEUTRAL] It looks like they were part of preventatives and we do not cover preventative or immunizations or anything like that.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And then the rest of it, um, it looks like there was no charges.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] So that's the, the whole denial.
[CUSTOMER][NEUTRAL] I got it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that does make sense. It looks like the way that it translated when it was entered into our system, it denied for like claim lack submission or billing errors, and we were like, OK, hold on, uh, so we're trying to figure out what the true denial for the claim was there, um, can you, uh, provide the claim number for this?
[AGENT][NEUTRAL] Yeah, mm.
[AGENT][NEGATIVE] Gotcha.
[AGENT][NEUTRAL] Sure, yes. That is 357-9280.
[CUSTOMER][POSITIVE] Perfect. Alright, so well I think this is all I needed um for today. If you do have a reference number, I will take it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't you can use my name in today's stage.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][POSITIVE] Perfect that sounds good then well I hope you have a wonderful rest of your day.
[AGENT][POSITIVE] You as well, Ms. [PII]. Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You too bye bye.