AccountId: 011433970860
ContactId: 254da69f-6159-450c-a241-4d0fd50b6fe2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 527020 ms
Total Talk Time (AGENT): 117416 ms
Total Talk Time (CUSTOMER): 108298 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/254da69f-6159-450c-a241-4d0fd50b6fe2_20250528T16:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, this is [PII] calling from provider office Imperial Health to check the claim status.
[AGENT][NEUTRAL] OK, [PII], happy to check a claim. What's the policy number?
[CUSTOMER][NEUTRAL] Um, it's 00750467.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the build amount.
[CUSTOMER][NEUTRAL] $407.45.
[AGENT][NEUTRAL] OK, I do show [PII], we received a claim for this state of service. claim was received on [PII].
[AGENT][NEUTRAL] Claim is processed on [PII].
[AGENT][NEUTRAL] There was a benefit payment made in the amount of $25.
[AGENT][NEUTRAL] This was the maximum for the date of service.
[CUSTOMER][NEUTRAL] So, uh, you paid $25 but the primary leftover amount is $55.
[AGENT][NEUTRAL] OK, yeah, the $25 was the max benefit payable for the state of service.
[CUSTOMER][NEUTRAL] So the remaining uh balance should be the uh provider responsible uh responsibility or the patient responsibility.
[AGENT][NEUTRAL] We're not able to advise on responsibility that's up to the facility or the provider.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Now I need the reference number for this member.
[AGENT][NEUTRAL] Call reference is my name with today's date. My name is [PII], which is [PII] Last initial is [PII], and then today's date.
[CUSTOMER][NEUTRAL] And I have one more member.
[AGENT][NEUTRAL] OK, let me just notate this and then we can move on to the next one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is the next member ID?
[CUSTOMER][NEUTRAL] 01633180.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Do the service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Fill them out.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] $492.95.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] So we did receive a claim for this. It looks like on [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Claim was denied on [PII].
[AGENT][NEGATIVE] The outpatient writer on this had been maxed out. The maximum visits per year were 5, and they had been exhausted for the year.
[CUSTOMER][NEUTRAL] So maximum uh per year you said is 5 for both of the CBD code?
[AGENT][NEUTRAL] I'm showing it was 99214 and 93,000.
[CUSTOMER][NEUTRAL] OK, but I can see from 99214 we have billed.
[CUSTOMER][NEUTRAL] Um, in 2024, we have built only 3 times previously.
[AGENT][NEUTRAL] OK, I mean, it is possible that the patient has seen a different provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you have that uh provider information or date of service?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] No, I do not.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] 93.
[CUSTOMER][NEUTRAL] 000
[CUSTOMER][NEUTRAL] And then 3000 is also we have uh 3 times previously.
[AGENT][NEUTRAL] Understood.
[CUSTOMER][NEUTRAL] So that also be in the same, I mean, for the different provider.
[AGENT][NEUTRAL] Yeah, I mean, it's possible the patient's seen a different provider.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can you also uh send me the copy of EOB for this one to my fax number?
[AGENT][NEUTRAL] What's the fax?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Should we mark attention to anybody?
[CUSTOMER][NEUTRAL] You can use my name, [PII].
[AGENT][NEUTRAL] OK, [PII], EOB should be there in 5 minutes. Is there anything else I can help with?
[CUSTOMER][NEUTRAL] Um, I just need the claim number for this one.
[AGENT][NEUTRAL] 359-421-4.
[CUSTOMER][POSITIVE] OK. Um, now I got all the information, so thank you so much and have a wonderful day.
[AGENT][NEUTRAL] You too.