AccountId: 011433970860
ContactId: 20dc65d9-ebcf-493f-be71-702ef265f5d1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 392880 ms
Total Talk Time (AGENT): 112754 ms
Total Talk Time (CUSTOMER): 174355 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/20dc65d9-ebcf-493f-be71-702ef265f5d1_20250224T14:32_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah. Hi, [PII]. This is [PII]. I'm calling from the provider office regarding the claim status. Last name initial would be [PII], and uh
[CUSTOMER][NEUTRAL] What about your uh last name, [PII]?
[AGENT][NEUTRAL] The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] All right. Thank you.
[AGENT][NEUTRAL] You're welcome, and [PII], may I
[CUSTOMER][NEUTRAL] So, uh, yep, uh, I'm calling from the query uh regarding the claim status. Thank you.
[AGENT][NEUTRAL] May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. The good contact number is [PII], direct line?
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, only one.
[AGENT][NEUTRAL] OK, may I have the member's policy number?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Sure. The member policy number is 01.
[CUSTOMER][NEUTRAL] 6602
[CUSTOMER][NEUTRAL] 58 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Wait a moment, please.
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][POSITIVE] Thank you for
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Sure, it's uh [PII].
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] Hotel bills are uh
[CUSTOMER][NEUTRAL] $340 even.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, and can you verify the name of the provider's office on the claim?
[CUSTOMER][POSITIVE] It's the associates of Manity. Thank you.
[AGENT][NEUTRAL] OK, this is it.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] The claim number is 31, I'm sorry, 3558814.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] [PII], you mean to sir?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEGATIVE] It's uh denied on [PII].
[AGENT][NEUTRAL] Yes, [PII] was the denial date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And denied as uh non-covered?
[AGENT][NEUTRAL] Code 9921, I'm sorry 9214 is denied because office visits are not covered on the policy. 92134.
[AGENT][NEUTRAL] was denied um because primary insurance provided full benefits.
[CUSTOMER][NEUTRAL] All right. So, basically, uh, the one code that is
[CUSTOMER][NEUTRAL] Deny it, right? It's uh 92134. And the second one is uh like already uh processed as a primary, right?
[AGENT][NEUTRAL] Both claims were denied. I mean both codes were denied, yes.
[CUSTOMER][NEGATIVE] So that's why it is denied.
[CUSTOMER][NEUTRAL] All right. So, uh, wait a moment, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, uh, the,
[CUSTOMER][NEUTRAL] I insurance left over like the $50 right?
[CUSTOMER][NEUTRAL] Is it on the 1st CPT code or 2nd CPT code?
[AGENT][NEUTRAL] Wait, what's your question again? I'm sorry.
[CUSTOMER][NEUTRAL] Uh, like the primary insurance leftover of $50 coinsurance? Is it on first line or second line?
[AGENT][NEUTRAL] Um, which code?
[AGENT][NEUTRAL] Um, I have to look at the documents you submitted. Hold on one second, let me pull up the document.
[CUSTOMER][NEUTRAL] Uh, like, uh.
[CUSTOMER][NEUTRAL] All right, all right.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] 99214.
[CUSTOMER][NEUTRAL] All right. 99214.
[CUSTOMER][NEUTRAL] So, uh, uh, is it non-covered under a patient policy or provider contract?
[AGENT][NEUTRAL] Patient policy.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] All right. So, uh, the $50 means the patient uh responsibility now, we have to bill the patient, right?
[AGENT][NEUTRAL] Well, we don't determine patient responsibility because we're not a major medical insurance, so it will be whatever your procedures are for outstanding balances.
[CUSTOMER][NEUTRAL] All right, all right.
[CUSTOMER][NEUTRAL] So we
[CUSTOMER][NEUTRAL] Yeah. So, uh, yeah, uh, that's it from my end for today's call.
[CUSTOMER][NEUTRAL] So, uh, is there any kind of reference number?
[AGENT][NEUTRAL] Um, no, there's no call reference number, but you can use my name in today's date. Again, the first initial to my last name is [PII] as [PII].
[CUSTOMER][NEUTRAL] So your name is [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Last name initial is [PII] and uh today's date, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] So, yup, uh, have a wonderful rest of your day and take care. Bye-bye. Thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL, Mark. Have a great day. Bye-bye.
[CUSTOMER][POSITIVE] Take care. Bye-bye. Thank you.
[CUSTOMER][NEUTRAL] OK.