AccountId: 011433970860
ContactId: 4f9582b7-71d3-47ec-bb4b-4abf1f6351a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 265630 ms
Total Talk Time (AGENT): 54038 ms
Total Talk Time (CUSTOMER): 162138 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/4f9582b7-71d3-47ec-bb4b-4abf1f6351a7_20250128T14:14_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling um with Trinity Health, uh Saint Peter's Health Partners, and I'm hoping I'm in the right place. Um, so I have, I'm, I'm trying to look into a claim, a denial that we received for a patient. Are you the right department to talk to?
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Yes, ma'am. Do you have a callback number I can get in case we get disconnected I can call you back.
[CUSTOMER][NEUTRAL] Yeah, sure. One minute.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] I do one minute.
[CUSTOMER][NEUTRAL] The policy number, so I have two. I have 02347343.
[CUSTOMER][NEUTRAL] If that is not it, I have another ID number.
[CUSTOMER][NEUTRAL] The patient's name is [PII].
[AGENT][NEUTRAL] And what's the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII] and you were just needing claim status?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, so I have a date of service of [PII], um, so there's been a lot of back and forth with this um with this account, and I'm I'm just trying to get some clarity, uh, so we've received a denial. Now, um, it looks like we did speak with an [PII], um, and I do have a reference number if you need that, um, but we did speak with an [PII] stating that there's a CBT code.
[CUSTOMER][NEUTRAL] 74018.
[CUSTOMER][NEUTRAL] That was denied um because it is not covered under the patient's uh benefits under their plan. But I had a question for a different CPT code that is for $102 and that is CPT code 76,770.
[AGENT][NEUTRAL] Hold on one moment. Let me look, look this up. Hold on one moment.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] OK, what was the procedure code? I'm sorry.
[CUSTOMER][NEUTRAL] OK 76,770.
[AGENT][NEUTRAL] Was there 2 procedure codes on this bill?
[CUSTOMER][NEUTRAL] So from what I have on this claim, I just have the 76,770, but it looks like when uh when we spoke with [PII], she provided a different CPT code.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 474018.
[AGENT][NEUTRAL] 70.
[AGENT][NEUTRAL] 418
[CUSTOMER][NEUTRAL] 7474.
[CUSTOMER][NEUTRAL] 018.
[AGENT][NEUTRAL] OK. I don't know [PII] in the claims department, so I'm not sure who that is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have a call reference number that she gave. I think it's just a date.
[AGENT][NEUTRAL] We don't give out call reference. Yeah, it's the name and the date we don't have call reference numbers.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Um, it looks like both of those were denied. Is that right?
[CUSTOMER][NEUTRAL] Yes, um, I, I only got the, the one CPT code. I just wanted to make sure, um, the 76,770, um, it was denied because it's not covered, it's not a covered benefit under her plan.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, that's, that's all I just wanted to confirm. I only had one CPT code. I didn't see the 76,770 CPT code that was denied, um, so I just wanted to make sure so I could uh call back the patient.
[AGENT][NEGATIVE] Yes, ma'am. It was denied for the same reason.
[CUSTOMER][POSITIVE] Got it. All right. All right, sounds good. Thank you so much, [PII]. I will go ahead and uh contact the patient and um let her know. Thank you so much.
[AGENT][POSITIVE] Thank you, [PII] for calling APO. You have a good day.
[CUSTOMER][POSITIVE] You too take care bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.