AccountId: 011433970860
ContactId: 2d8b6dfb-faa8-48df-abba-3f51df2f0f81
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 215210 ms
Total Talk Time (AGENT): 52848 ms
Total Talk Time (CUSTOMER): 94829 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/2d8b6dfb-faa8-48df-abba-3f51df2f0f81_20250401T16:37_UTC.wav
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[AGENT][NEUTRAL] For calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm calling for the provider to check on the additional information about your claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes. Yes, please, [PII].
[AGENT][POSITIVE] I'd be happy to assist with claim status today [PII], if I can get a good call back number for you.
[CUSTOMER][POSITIVE] Thank you so much. The best callback number will be [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and it is a direct line.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Policy number starts with 02538451.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's complete name is [PII]. Date of birth is on [PII].
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] Date of service on [PII].
[AGENT][NEUTRAL] And what's your tax ID?
[CUSTOMER][NEUTRAL] The tax ID is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. So I'm showing that the claim we received it twice the first time a payment was made in the amount of.
[AGENT][NEUTRAL] One moment, let me see.
[CUSTOMER][NEUTRAL] I showing it is paid for initially $63.04. However, it's partially denied for 99204. That's fine.
[AGENT][NEUTRAL] That we, we stated on the EOB that that's not a covered procedure code under the policy.
[CUSTOMER][NEUTRAL] So offices are not covered under this patient's plan, is it correct?
[AGENT][NEUTRAL] No, only the treatment and procedures at the visit, which is why we pay the other two procedure codes. Those are covered. The 99204 is not covered.
[CUSTOMER][NEUTRAL] Thank you. So this procedure is not covered under the patient's plan means the patient's plan, patients have a med link select group, medical supplemental plan, is it correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you. And one moment, please. The reason was claim was denied as a duplicate, the claim number ending with 3287. Is that the correct information?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Thank you. I'm ready to take the call reference number for our conversation, please.
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] Thank you so much for your assistance on the passing clarification. And as you mentioned before the date, today's date, I, I can get it, but the time, please.
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][POSITIVE] [PII] Eastern Standard Time. Thank you so much. Is it correct or Central time?
[AGENT][NEUTRAL] We're Central.
[CUSTOMER][NEUTRAL] One.
[CUSTOMER][POSITIVE] Thank you so much for your assistance and have a great day.
[AGENT][POSITIVE] Thank you for calling APL have a good day.
[CUSTOMER][POSITIVE] Thank you.