AccountId: 011433970860
ContactId: 22b6f7ae-5c4e-4496-a08e-f926016e50e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 281470 ms
Total Talk Time (AGENT): 96332 ms
Total Talk Time (CUSTOMER): 108508 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/22b6f7ae-5c4e-4496-a08e-f926016e50e4_20250225T19:59_UTC.wav
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[AGENT][POSITIVE] Good afternoon thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, yeah. Hi, [PII]. This is [PII], and I'm calling for providers to check on the additional information about a claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes. How are you doing today?
[AGENT][POSITIVE] I'm doing well, thank you for asking, [PII]. How are you doing?
[CUSTOMER][POSITIVE] Yeah, I'm doing well. Thank you so much for asking. Your name is [PII]?
[AGENT][NEUTRAL] It is, and the first initial of my last name is [PII]. And [PII], can I get a good callback number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure, it will be [PII]. This is the direct line with the [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the claim number or policy number?
[CUSTOMER][NEUTRAL] Yes, I have a claim number is 3560078.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] It is [PII]. The date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] So
[AGENT][POSITIVE] And it would be my pleasure to assist you with that claim information. And can you verify the facility name, please?
[CUSTOMER][NEUTRAL] Yes, the name is Carolina Orthopedic and Neurosurgical Associates, PA.
[AGENT][NEUTRAL] All right, thank you, and I can help you with that claim information. Now, [PII], this claim was denied.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Because k kinesiology, speech, or occupational therapy is not covered.
[AGENT][NEUTRAL] Per the policy guidelines, that's correct.
[CUSTOMER][NEUTRAL] As per the patient's plan.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So this claim was frozen denied on [PII], right?
[AGENT][NEUTRAL] It was, yes, sir.
[CUSTOMER][NEUTRAL] I don't do [PII].
[CUSTOMER][NEUTRAL] Claim number is 3560078.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the CPT code which is 9,711,097,140.
[CUSTOMER][NEUTRAL] Denied for the reason, gynecology, speech, or occupational therapy are not covered as per the patient's policy, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] The patient's plan name is?
[AGENT][NEUTRAL] It's a meddling gap policy.
[CUSTOMER][NEUTRAL] My name is
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm. [PII]
[CUSTOMER][NEUTRAL] Yeah, it's like, uh-huh.
[AGENT][NEUTRAL] Gap policy.
[CUSTOMER][NEUTRAL] Uh-huh. Gap policy.
[CUSTOMER][NEUTRAL] So the remaining charges will be the patient responsibility of providers right off.
[AGENT][NEUTRAL] We're secondary. We do patient responsibility that would be determined. We are secondary policy, not major medical. We don't determine patient responsibility.
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the remaining charges will be the provider right off, right?
[AGENT][NEUTRAL] That would be determined by the provider.
[CUSTOMER][POSITIVE] OK, thank you. Very fine.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] remaining non-covered charges will be the providers right now.
[AGENT][NEUTRAL] It would be determined by the provider. We can't.
[AGENT][NEUTRAL] Um, determine whether it's whether it's a write-off or bill patient.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] So, may I get the call reference number?
[AGENT][NEUTRAL] Oh reference number is my name and today's date.
[CUSTOMER][NEUTRAL] [PII], today's date.
[AGENT][POSITIVE] That's correct, [PII], and it's been a pleasure to assist you with that claim information. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] And that's all for that. Thank you so much. Have a great day ahead.
[AGENT][POSITIVE] I hope you have a great day as well, [PII], and thank you for calling APL. Take care.
[CUSTOMER][NEUTRAL] Right now be said.
[CUSTOMER][NEUTRAL] I think
[AGENT][NEUTRAL] Bye bye.