AccountId: 011433970860
ContactId: 3e7b1a0e-0389-4b6a-8c37-8ad7c124daae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 685349 ms
Total Talk Time (AGENT): 185573 ms
Total Talk Time (CUSTOMER): 212013 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/3e7b1a0e-0389-4b6a-8c37-8ad7c124daae_20250122T22:12_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][POSITIVE] Thank you for calling APL.
[CUSTOMER][NEUTRAL] Hi, [PII].
[AGENT][POSITIVE] Hi, how can I help today?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Hi, um, my name is [PII]. Initial to my last name is [PII]. I'm calling from the doctor's office to check on a claim status.
[AGENT][NEUTRAL] OK, [PII], I'm happy to check on a claim for you today. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, the patient's policy ID is 19407.
[AGENT][NEUTRAL] Let me take a look here, one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] What is the patient's first and last name?
[CUSTOMER][NEUTRAL] And uh that's [PII].
[CUSTOMER][NEUTRAL] [PII] was born on [PII].
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] OK, that uh number doesn't come up with that information. Do you have any other policy or certificate number for the member?
[CUSTOMER][NEUTRAL] Uh, no, ma'am. Uh, does it mismatch with the policy ID number or the patient's name?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I can search by their name if you can spell it.
[CUSTOMER][NEUTRAL] Uh, sure.
[CUSTOMER][NEUTRAL] Um, the first name is [PII], that's [PII].
[CUSTOMER][NEUTRAL] And the last name is spelled as uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, let me take a look by the name.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah, there is also space after that and uh that is uh.
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] All right, and then what is the date of service?
[CUSTOMER][NEUTRAL] Yeah. And the date of service is [PII]. And the total bill amount is $2,042 even.
[AGENT][NEUTRAL] All right, let me take a look here, one moment.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Do you have an amount due after the primary?
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is that amount?
[CUSTOMER][NEUTRAL] And that was.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] That's $295.67.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, we don't have any claims on file for that date of service matching that bill amount.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One second, ma'am. Give me just a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] By chance, are you able to find any other claim for the same date of service?
[CUSTOMER][NEUTRAL] Uh, that is for.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And uh
[AGENT][NEUTRAL] We have 2 claims on file but for different amounts.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, do you have $2,575 even?
[AGENT][NEUTRAL] No, we do not.
[CUSTOMER][NEUTRAL] OK, can you please go ahead and once verify me, uh, what are all the CPT codes, uh, that is being built on the claims that you do find with the different bill amount?
[AGENT][NEUTRAL] We have procedure code 99215933259332093005.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Adding to that, do you also find 93303 on it?
[AGENT][NEUTRAL] Uh, that was a separate claim that we did receive and there was a benefit payment sent for that one.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah. Uh, can you please go ahead and provide me the status of those two claims?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, the procedure code of 93303 was a billed amount for $47.14. A payment was sent in that amount.
[CUSTOMER][NEUTRAL] 93303. Uh, may I know how much was paid on it, ma'am?
[AGENT][NEUTRAL] Uh, the claim benefit payment was for $47.14.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] All right. And can you please uh provide me the claim number for this particular CPD code built?
[AGENT][NEUTRAL] 353.
[AGENT][NEUTRAL] 972 3.
[CUSTOMER][NEUTRAL] Got it, ma'am. Can you please go ahead and provide me with the uh other claim that you do have?
[AGENT][NEUTRAL] Other claim that was received date of service [PII]. It was for a billed amount of $113.41.
[AGENT][NEUTRAL] A benefit payment was sent in the amount of 11341.
[AGENT][NEUTRAL] The claim number for this is 353-850-8.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Can you please let me know when my, uh, what the claims received and processed.
[AGENT][NEUTRAL] Uh, this claim that we are speaking on was received [PII], processed [PII].
[AGENT][NEUTRAL] The previous claim was received on [PII].
[AGENT][NEUTRAL] And process [PII].
[CUSTOMER][NEUTRAL] Can you please go ahead and provide me with the uh second claim uh payment information, the check or EFT number when was it cleared?
[AGENT][NEUTRAL] Uh, let me go back to that claim.
[AGENT][NEUTRAL] The one for 4714.
[CUSTOMER][NEUTRAL] No, not that one. The one for, uh, 1341, you mean?
[AGENT][NEUTRAL] Oh, the other one, OK.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] I'm doing.
[AGENT][NEUTRAL] Um, so it looks like the payment for 11341 uh was issued on [PII] sent to [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] We're
[AGENT][NEUTRAL] To pediatrics Medical Group.
[CUSTOMER][NEUTRAL] And please check our EFT number, please?
[AGENT][NEUTRAL] The check number is 2017468.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] May I know when was it cleared?
[AGENT][NEUTRAL] I don't have a date. It has been cached.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Is it just that uh you would get an update whether it was cashed or not, but no date information, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. Is it possible from your end to go ahead and fax me the copy of explanation of benefits?
[AGENT][POSITIVE] Absolutely, I can send that over to you. What is a good fax number?
[CUSTOMER][NEUTRAL] Yeah. And uh the fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 33543.
[CUSTOMER][NEUTRAL] Attention would be my name, [PII].
[AGENT][POSITIVE] OK, [PII], that is on its way. You should be there in the next 5 minutes. Is there anything else I can help with today?
[CUSTOMER][NEUTRAL] Uh, yeah, ma'am. Can you please spell out your name for documentation?
[AGENT][NEUTRAL] My name is spelled [PII].
[CUSTOMER][NEUTRAL] Yeah. And uh how about the call reference number for today's call?
[AGENT][NEUTRAL] Call references my name with my last initial than today's date. The last initial to my name is [PII], and today's date.
[CUSTOMER][POSITIVE] Got it, [PII]. Thank you so much for your assistance, ma'am. Hope you enjoy the rest of your day and stay safe.
[AGENT][NEUTRAL] You too bye bye.