AccountId: 011433970860
ContactId: 4ac82eaf-f963-442d-bd7b-14e41cd9c411
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 496859 ms
Total Talk Time (AGENT): 186154 ms
Total Talk Time (CUSTOMER): 143558 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/4ac82eaf-f963-442d-bd7b-14e41cd9c411_20250411T17:42_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from NYU to check on the claim status. How are you doing today?
[AGENT][POSITIVE] I'm doing well, sir. How are you?
[CUSTOMER][POSITIVE] I'm doing great as well. Thank you for asking.
[AGENT][POSITIVE] That's good and I'll be um more than happy to help you with, you said the claim status, the phone is breaking up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Can you hear me now?
[AGENT][NEUTRAL] Yes, I can hear you. Did you say it was for claim status?
[CUSTOMER][NEUTRAL] Can you hear me now, [PII]?
[CUSTOMER][NEUTRAL] Yes, yes, yes, claim status.
[AGENT][NEUTRAL] OK, and just for my notes, can you spell your first name for me please and provide a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, the first name is [PII] and my last name is [PII]. And the phone number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. The member policy number I have here is 02559264.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. The member first name is [PII] and the date of birth is on, the, the first name is [PII], last name is [PII]. Uh, the member's date of birth is on [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service and the total bill for the claim you like me to check on?
[CUSTOMER][NEUTRAL] [PII]. With the bill amount of $2090 even.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And [PII], do you mind if I place you on just a brief hold while I look through these claims?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 356-6056358.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] 2090.
[AGENT][NEUTRAL] 56 3566.
[AGENT][NEGATIVE] It was a dupe though.
[AGENT][NEUTRAL] Of the 4, yeah.
[AGENT][NEUTRAL] So 802. What you gonna do?
[AGENT][NEUTRAL] Uh, that's it.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, the provider office I have in the claim is one moment, [PII]. I'm just pulling up that. The provider name is [PII]. The provider office is NYU Langone Dupa Associate.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you for that, and I'm showing that we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3, go ahead.
[CUSTOMER][NEUTRAL] Uh, yeah, yeah, you just go ahead, [PII].
[AGENT][NEUTRAL] Claim number is 358.
[AGENT][NEUTRAL] 1802.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider.
[AGENT][NEUTRAL] A total of $500.
[AGENT][NEUTRAL] Did you need that check information?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, no, no, no. Uh, one moment, [PII]. On the claim, I can able to see that CPT.
[CUSTOMER][NEUTRAL] 834138305. 1 moment, one moment.
[CUSTOMER][NEUTRAL] Yeah, sorry for the delay. The CPT 8341 and 305 is being paid, [PII]. So the CBD 8342 is being uh denied, which is being partially paid and I have the balance of $153 even. So may I know why the CBD 8342 is being denied here?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, the maximum benefit payable for the data service has been met. So the, let me see what the benefit is. Hold on one moment.
[AGENT][NEUTRAL] So the outpatient um
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Calendar day maximum is $500 and that $500 was applied between the two codes. So that last code couldn't be paid because the max was already paid.
[CUSTOMER][NEUTRAL] So the $500 is paid to CPT 8341 9305, right?
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] Correct, $384.44 was applied to 88305 and $115.56 was applied to 88341, which totals $500.
[CUSTOMER][NEUTRAL] OK. 2 8341. OK. Just one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, may I just have the, uh, payment details of the two CPT?
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So the check number, it was a single check.
[AGENT][NEUTRAL] In the amount of $500.
[AGENT][NEUTRAL] Check number is 203.
[AGENT][NEUTRAL] 5701.
[AGENT][NEUTRAL] The check was mailed to [PII] in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code [PII].
[AGENT][NEUTRAL] So if the check has not been received by [PII], you can give us a call back and we can check on the check and reissue it if needed.
[CUSTOMER][NEUTRAL] OK. So the you need that uh $500 for the whole for the whole claim date, not for a particular CPT.
[CUSTOMER][NEUTRAL] Like I'm asking, and now like the the
[AGENT][NEUTRAL] So the 500
[CUSTOMER][NEUTRAL] Yeah, yeah, go ahead, go ahead. Sorry.
[AGENT][NEUTRAL] The $500 the, the benefit is per calendar day. So for the day of [PII], we broke the $500 down between the two codes.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] OK. OK. OK, [PII]. In that case, can I have the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date.
[AGENT][NEUTRAL] And agai[PII], that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK. OK, [PII]. In that case, thank you for your assistance. Have a great day.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that's it for today. Thank you and have a nice day.
[AGENT][POSITIVE] All right. You're welcome. Thanks for calling API. Have a great weekend. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye. Mhm.