AccountId: 011433970860
ContactId: 3cfc2004-d84d-4825-942f-c0c980c386b7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 211210 ms
Total Talk Time (AGENT): 78719 ms
Total Talk Time (CUSTOMER): 102593 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/3cfc2004-d84d-4825-942f-c0c980c386b7_20250129T16:51_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] you.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], my name's [PII].
[CUSTOMER][NEUTRAL] How are you today?
[AGENT][POSITIVE] Hey [PII], I'm good. How are you?
[CUSTOMER][NEUTRAL] I'm hanging, um, no other choice, right? Uh, I am calling from a provider's office, medical.
[CUSTOMER][NEUTRAL] And just wanted to follow up on a claim we filed a while ago on a member that we haven't heard from y'all I'll make sure we're doing it right.
[AGENT][NEUTRAL] Sure, I can assist you with that, [PII]. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] Callback number is [PII] and the policy number is 02341380.
[AGENT][NEUTRAL] What is that member's name and date of birth?
[CUSTOMER][NEUTRAL] The patient is [PII]. Date of birth [PII].
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] And you're calling to verify benefits and eligibility for what place of service?
[CUSTOMER][NEUTRAL] I need to
[CUSTOMER][NEUTRAL] No, I just need to know if y'all received the claim, uh.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Sorry
[CUSTOMER][NEUTRAL] And the total bill amount on that day to their primary insurance was $476.01.
[AGENT][NEUTRAL] [PII], could you provide me with a procedure code?
[CUSTOMER][NEUTRAL] Um, CPT 99203.
[CUSTOMER][NEUTRAL] Oh, you know what? Wait a minute, wait a minute, wait a minute, yeah.
[CUSTOMER][NEUTRAL] That well that's the, I mean there were, there are two procedure codes, but their primary took care of everything except for the balance on the 99203.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] There was also 11102.
[AGENT][NEUTRAL] 515514.
[AGENT][NEUTRAL] 55145 so we've received the claim.
[AGENT][NEUTRAL] [PII], it was processed [PII]. There was no payment made on the claim because procedure code of 99203 was denied as office visits not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Procedure code 11102 and G8484 was denied as treatment received in the office not covered. So the policy does not cover the office visits nor the treatment received in the office.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, well, they had already done all the treatments, so, um, I have to build the patient this balance. I certainly appreciate your time today, [PII], and have a great rest of your week.
[AGENT][POSITIVE] Thank you [PII], is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] No, is there a reference number for our call?
[AGENT][NEUTRAL] We don't provide those, however, you can use my name in today's date as a reference, and would you like the claim number?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] The claim number is 3475514. That's 3475514 and my name is [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 5514.
[CUSTOMER][POSITIVE] Perfect thanks [PII] you have a great one. I appreciate you.
[AGENT][POSITIVE] You do the same, [PII]. Thanks for calling APA. You have a great day.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][POSITIVE] Thank you you too.