AccountId: 011433970860
ContactId: 26929dc1-1466-47b4-b72d-e928d38ddd28
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 399940 ms
Total Talk Time (AGENT): 182091 ms
Total Talk Time (CUSTOMER): 90204 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/26929dc1-1466-47b4-b72d-e928d38ddd28_20250107T22:13_UTC.wav
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[AGENT][NEUTRAL] Hey, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, good day. I'm just calling for claim status.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with some claim status today and.
[AGENT][NEUTRAL] May I get your name and a good call back number please?
[CUSTOMER][NEUTRAL] My name is [PII]. Callback number is [PII], a direct line.
[AGENT][POSITIVE] Perfect. I really appreciate that. And what's the member's policy number?
[CUSTOMER][NEUTRAL] The policy number is, one moment, sorry.
[AGENT][POSITIVE] No worries, take your time.
[CUSTOMER][NEUTRAL] It's 01822311 M as in Mary, L as in lion, and then the number 8.
[AGENT][POSITIVE] Perfect. Thank you so much. And can you verify for me your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII], last name [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Perfect thank you and you said you were looking for claim status. Do you have a claim number or are you looking for a certain date of service?
[CUSTOMER][NEUTRAL] Um, no claim number. Um, the date of service is September [PII] of 2024.
[AGENT][NEUTRAL] OK, give me one second to check something.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] 0927 2024. Did I hear that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, perfect. Um, your patient does have an updated policy number with us, and I can give that to you if you want it, but it did just take me a second to get into the new policy.
[AGENT][NEUTRAL] Um, and then what was the total?
[CUSTOMER][NEUTRAL] OK, I will take it.
[AGENT][NEUTRAL] What was the total bill amount on that?
[CUSTOMER][NEUTRAL] Um, the original claim or the after primary paid?
[AGENT][NEUTRAL] Um, after primary paid, but I'm sorry.
[CUSTOMER][POSITIVE] It's 75. No worries.
[AGENT][NEUTRAL] 75. OK, perfect. And then yes, that updated policy number is 02443498.
[AGENT][NEUTRAL] And what is the
[AGENT][NEUTRAL] I'm so sorry, what is the name of the facility on file for the claim you wanna look at?
[CUSTOMER][NEUTRAL] It's Genesis Care.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, South Florida.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right, perfect. Thank you so much and.
[AGENT][NEUTRAL] I believe this is your claim right here. I have your claim was received on.
[AGENT][NEUTRAL] [PII]. I show that the claim was processed on [PII], and I do show that that claim had benefits payable of $3.61. It looks like that was paid via check for.
[AGENT][NEUTRAL] Um, I'm so sorry, a check and the check number is 2008116. Let me pull up those check details for you.
[AGENT][NEUTRAL] It looks like that check was issued on [PII] and cleared on [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And then is there any other information I can give you in regards to this claim?
[CUSTOMER][NEUTRAL] Um, yes. What was the claim number?
[AGENT][NEUTRAL] Oh my gosh, I'm sorry I think I just skipped right through that um the claim number is 313517924.
[CUSTOMER][NEUTRAL] 351-792-4. OK.
[AGENT][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And where did you pay, where was it paid to, like the address, the payable address?
[AGENT][NEUTRAL] Yeah, it went to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that's correct.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] And you said 361 was um paid and the rest is.
[CUSTOMER][NEUTRAL] A contractual?
[AGENT][NEUTRAL] Um, because for a secondary insurance we can't determine patient responsibilities. We can only just pay out in the benefits payable. It does look like the procedure code 99214 was um denied as office visits are not covered under the numbered policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, I see.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Oh, it's my pleasure. Is there anything else I can do to help you, my friend?
[CUSTOMER][NEUTRAL] Um, just a reference number.
[AGENT][NEUTRAL] Certainly, it's gonna be my name, [PII], first initial last name, [PII], and then today's date.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Oh my pleasure if you need anything else just give us a call and you have a wonderful day.
[CUSTOMER][POSITIVE] You have a good day as well.
[AGENT][POSITIVE] Thank you. You too. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.