AccountId: 011433970860
ContactId: 40130974-e24b-4bf4-b163-0d3b562565fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 230490 ms
Total Talk Time (AGENT): 106981 ms
Total Talk Time (CUSTOMER): 66082 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/40130974-e24b-4bf4-b163-0d3b562565fc_20250130T15:42_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I'm calling regarding a claim. I, I need some information on.
[AGENT][POSITIVE] It would be my pleasure to assist you. And what is your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] And a good callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And do you have a claim number or the policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I have the policy of the
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 01699521
[AGENT][NEUTRAL] Thank you, [PII]. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Alright thank you and I can look it up by the data service. What is that data service?
[CUSTOMER][NEUTRAL] 82923.
[AGENT][NEUTRAL] 829 23, and what is that bill amount please ma'am?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] One second, uh, 66492.
[AGENT][NEUTRAL] 66492.
[AGENT][NEUTRAL] What is the facility name?
[CUSTOMER][NEUTRAL] Baptist Health Medical Group [PII].
[CUSTOMER][NEUTRAL] Are you seeing a different amount?
[AGENT][NEUTRAL] What's the CPT code?
[CUSTOMER][NEUTRAL] Um, we have 21 is 99214 and 73,610.
[AGENT][NEUTRAL] We only have the claim for the 73,610.
[CUSTOMER][NEUTRAL] That's weird.
[AGENT][NEUTRAL] I'm gonna pull it up just to make sure that other code is not listed. Bear with me just one second.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] And it's for 14884?
[CUSTOMER][NEUTRAL] Um, that charge, yes.
[AGENT][NEUTRAL] Yeah, that is the only code this, oh.
[AGENT][NEUTRAL] And look this is weird.
[CUSTOMER][NEUTRAL] Oh, the other code was paid all by Medicare, I guess. I don't know why, but it appears to be.
[AGENT][NEUTRAL] Yeah, that's, that is the only code we have listed is the one the 73,610.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] All right, so what happened with that?
[AGENT][NEUTRAL] OK, all right.
[AGENT][POSITIVE] I can help you with that.
[CUSTOMER][NEGATIVE] Cause I have a duplicate denial and I don't understand why.
[AGENT][NEUTRAL] OK, so that was pro it well we received the claim on [PII] and processed on [PII]. Now we received the claim again, but it was denied as a uh duplicate, so I'm giving you the original claim information.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this claim was denied because services are not covered when performed in a doctor's office.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] So it's the place of service.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Who is responsible, the patient or?
[CUSTOMER][NEUTRAL] Provider.
[AGENT][NEUTRAL] So we're secondary, not major medical. We don't determine patient responsibility. That would be determined by the provider and major medical.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And would you like that claim number, [PII]?
[CUSTOMER][NEUTRAL] Um, can I get a reference number for the call?
[AGENT][POSITIVE] Absolutely, the reference number is my name and today's date, and I spell my name [PII]
[AGENT][NEUTRAL] First initial, last name, [PII]. Anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] All right. No, that's it. Thank you.
[AGENT][POSITIVE] It's been my pleasure and thank you for calling APL. I hope you have a lovely day.
[CUSTOMER][NEUTRAL] You too bye bye.