AccountId: 011433970860
ContactId: 3223e2aa-4f56-458c-8879-e3d2f8425b8d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 181089 ms
Total Talk Time (AGENT): 65107 ms
Total Talk Time (CUSTOMER): 84437 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/3223e2aa-4f56-458c-8879-e3d2f8425b8d_20250127T14:45_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII] calling from Cookville Regional Medical Group. We received a, we met.
[CUSTOMER][NEGATIVE] On a claim a partial payment, but I need to go over one of the procedures to make sure this is, this was denied correctly.
[AGENT][NEUTRAL] OK, and I'm sorry, spell your name for me.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, what's the policy number, [PII], and the claim number?
[CUSTOMER][NEUTRAL] Claim number is 3549818, the policy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Excuse me, the policy number.
[CUSTOMER][NEUTRAL] I have it on here is 02512593.
[AGENT][NEUTRAL] And what is a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] and that is my direct line.
[AGENT][POSITIVE] Thank you for that. One moment.
[CUSTOMER][NEUTRAL] I don't know if that policy number is correct.
[AGENT][NEUTRAL] I could search it by the claim if it's not.
[AGENT][NEUTRAL] By the claim number?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] That is the correct.
[AGENT][NEUTRAL] Policy number.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And so was this for an office visit fee?
[CUSTOMER][NEUTRAL] Yeah, it was a for an office visit and then they, which they paid the $50 but I have a CPT code that was the 952-51, and you guys are denying it same for maximum, is that correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct, right, so the maximum benefit for servicing a physician's office is $50 and that was paid towards the physician visit fee.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, are we allowed to bill this patient with $70?
[AGENT][NEUTRAL] We do not determine patients responsibility, [PII].
[AGENT][NEUTRAL] So the remark says that the maximum benefit is exhausted.
[AGENT][NEUTRAL] That's the extent of our processing for this claim, and we can't tell you what to bill and what they owe that's up to the provider based on the remark on that claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you guys pretty much only pay $50 and that's it, and then.
[AGENT][NEUTRAL] That's the benefit for office service in an office setting?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can I get a um
[CUSTOMER][NEUTRAL] Call reference number please.
[AGENT][NEUTRAL] Uh-huh. You'll use my name in today's date as your reference, [PII].
[CUSTOMER][POSITIVE] OK, [PII], thank you very much for your help. You have a good safe day, [PII].
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.