AccountId: 011433970860
ContactId: 4ed82083-9d94-4b8c-aa1e-60156384a42b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 546859 ms
Total Talk Time (AGENT): 130708 ms
Total Talk Time (CUSTOMER): 144188 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/4ed82083-9d94-4b8c-aa1e-60156384a42b_20250527T16:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm calling for a provider to check on additional information about a claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes. Could you please spell out your name?
[AGENT][NEUTRAL] Yes, my name is [PII]
[AGENT][NEUTRAL] And [PII], what is your call back number just in case our call is disconnected.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK. The callback number is [PII]. It's a direct line, no extension.
[AGENT][NEUTRAL] Thank you, and then may I please have the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure. The member's name is [PII], and the date of birth is [PII]. And the policy number is
[CUSTOMER][NEUTRAL] 60801
[AGENT][NEUTRAL] OK, that is our payer ID number. Do you see another number that could be the policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number is 01659744.
[AGENT][NEUTRAL] OK, let me pull up that policy real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then what is the data service and the charge amount?
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes. The bill amount is $197.32.
[AGENT][NEUTRAL] OK, and what is the date of service?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, and then what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] That is 197.32.
[AGENT][NEUTRAL] OK and then can you give me the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Sure. It's Foot ankle and Le Specialists of South Florida Incorporation.
[AGENT][NEUTRAL] OK and you said that this claim has already been denied, will you please give me the claim number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The claim number is 95, it's 3597455.
[AGENT][NEUTRAL] 7455.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim and I'll be right back with you, [PII].
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] You
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you very much, [PII], for holding for me.
[AGENT][NEUTRAL] OK, so the claim number that you give, you gave me is on a different policy number. Let me give you that policy number that the claim is on.
[CUSTOMER][NEUTRAL] Welcome.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It is policy number 1659744.
[AGENT][NEUTRAL] The claim was paid $50.
[AGENT][NEUTRAL] With a check number.
[AGENT][NEUTRAL] 204-2791 after that payment it maxed out the benefit for the day's service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much. So, I'm checking for the denied CPT code, that is L4360.
[AGENT][POSITIVE] Right, and durable medical.
[CUSTOMER][NEUTRAL] So could you please provide the additional information? Mhm.
[AGENT][NEUTRAL] Yes, durable medical equipment is not covered under this policy under the patient's plan.
[CUSTOMER][NEUTRAL] OK. So the code L4360 is denied as durable medical equipment is not covered under the member's plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] So, may I know the member's plan name?
[AGENT][NEUTRAL] Medlink.
[CUSTOMER][NEUTRAL] Uh sorry member has the meddling plan, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] And
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you for the information.
[CUSTOMER][NEUTRAL] So, could you please verify the denied date?
[AGENT][NEUTRAL] Yes ma'am, let me look that up.
[CUSTOMER][NEUTRAL] Is that [PII] of
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's gonna be just a minute while my computer pulls it in.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] Of [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So, can I get the call reference number for the client?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] Thank you for assisting. Have a great day.
[AGENT][POSITIVE] You have a wonderful day too, [PII]. Is that everything I can help you with before we go?
[CUSTOMER][POSITIVE] Yes, that's all for today. Thank you for assisting.
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] OK. You're very welcome. Thank you for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.