AccountId: 011433970860
ContactId: 291d23fd-e472-4748-9be9-f5c1e7ca849f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 264839 ms
Total Talk Time (AGENT): 120627 ms
Total Talk Time (CUSTOMER): 90419 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/291d23fd-e472-4748-9be9-f5c1e7ca849f_20250319T19:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], I'd like to check claim status, please.
[AGENT][NEUTRAL] OK, are you calling from the provider's office?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, may I have your name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you and your call back number please [PII].
[CUSTOMER][NEUTRAL] [PII], I mean I'm sorry [PII].
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, let me just repeat the last four digits. I have that as excuse me, [PII] for the last four.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what is the policy number, please, [PII]?
[CUSTOMER][NEUTRAL] It's 0175.
[CUSTOMER][NEUTRAL] 122 4
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] OK, thank you. And to repeat and confirm, I have that as 01751224 ML8.
[CUSTOMER][NEUTRAL] ML 8
[AGENT][NEUTRAL] Yes, and verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII]. Birth date is [PII].
[AGENT][NEUTRAL] Thank you, and your call for claim status, [PII]. I can help you. What is the date of service, please, and total charge amount?
[CUSTOMER][NEUTRAL] The service date is [PII]. The total is 489.
[AGENT][NEUTRAL] 489 thank you one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Almost done.
[AGENT][NEUTRAL] 489. OK, I believe I have a claim here. If you could just verify the procedure color codes bill please.
[CUSTOMER][NEUTRAL] The CPT is 99213 following 11102.
[AGENT][NEUTRAL] OK
[AGENT][NEGATIVE] OK, thank you very much for the information. It shows that the claim was received and it denied. Um, procedure code 99213 denied as office visits are not covered by the policy and procedure code 11102 denied as service not covered, excuse me, service not covered when performed in the doctor's office.
[CUSTOMER][NEUTRAL] So the, OK, so office visits are not covered and, and the biopsy is not covered in, in the doctor's office?
[AGENT][NEUTRAL] Correct, any service or procedure inside the office is not covered.
[CUSTOMER][NEUTRAL] Not covered. OK, do we have a claim number?
[AGENT][NEUTRAL] Yes, the claim number is 3576863.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh my God, excuse me.
[AGENT][NEUTRAL] OK, no problem, I can repeat that.
[CUSTOMER][POSITIVE] OK, I need to, I need you to please do so. Thank you.
[AGENT][NEUTRAL] You're welcome. It is 357-686-3.
[CUSTOMER][NEUTRAL] And when was that processed?
[AGENT][NEUTRAL] OK, let me get the information for you one moment.
[CUSTOMER][NEUTRAL] Yeah, because I'm gonna have to physically post it.
[AGENT][NEUTRAL] It was processed on yesterday.
[CUSTOMER][NEUTRAL] Oh, OK. I, so it was just processed at [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, I'll, I'll allow the time and I'll put a note on it and so forth. Thank you so much, [PII]. Do we get a reference number?
[AGENT][NEUTRAL] You're welcome, [PII]. We do not use reference numbers, but you can use my name in today's state. My last initial is [PII], and also, Miss [PII], you're able to get that EOB from our website, and that is [PII].
[CUSTOMER][POSITIVE] [PII], I'm sorry, [PII].
[AGENT][POSITIVE] [PII].
[CUSTOMER][NEUTRAL] Oh [PII]. Uh-huh.
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you so much for that information. I appreciate it.
[AGENT][POSITIVE] You're welcome. You're very welcome, Miss [PII], and thank you so much for calling APL. You have a great day.
[CUSTOMER][NEUTRAL] You too. OK. Bye-bye.
[AGENT][POSITIVE] Thank you. Mm bye bye.