AccountId: 011433970860
ContactId: 510794f9-15d5-4bee-b352-692351809d71
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 271459 ms
Total Talk Time (AGENT): 68068 ms
Total Talk Time (CUSTOMER): 98310 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/510794f9-15d5-4bee-b352-692351809d71_20250331T17:25_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] from Brown Health. How are you today?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][NEUTRAL] Good, I'm checking on a claim that uh is a secondary claim.
[AGENT][POSITIVE] I'll be happy to assist with the claim today, [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Uh yes, [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Um, policy number is 02404350M as in Mary, L as in Lima H.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Data service for the claim?
[CUSTOMER][NEUTRAL] 11025.
[AGENT][NEUTRAL] And your tax ID.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you for that information.
[AGENT][NEUTRAL] OK. Now, what's the CPT code? It looks like we received.
[AGENT][NEUTRAL] Two different claims.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] So it looks like um it looks like actually my claim split it um.
[CUSTOMER][NEUTRAL] It was $274.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] So the CPT 9612. OK. So that denied because it's not covered.
[CUSTOMER][NEUTRAL] We're looking for the copay on the.
[CUSTOMER][NEUTRAL] 7
[AGENT][NEUTRAL] The $260 charge?
[CUSTOMER][NEUTRAL] OK, we're looking at uh visit.
[CUSTOMER][NEUTRAL] Mhm, for the $25.
[AGENT][NEUTRAL] The $260 to.
[CUSTOMER][NEUTRAL] Yeah, it was a, it's $260 but we're looking for the co-payment.
[AGENT][NEUTRAL] So I'm trying to explain to you that that denied because that is that charge that 99214 is not covered under the policy.
[CUSTOMER][NEUTRAL] Oh, office visits?
[AGENT][NEUTRAL] Only treatment and procedures at the visit is covered. The co-pay associated with the physician's charges is not.
[CUSTOMER][NEUTRAL] Oh, OK. Treatment and procedures.
[CUSTOMER][NEUTRAL] Did you, did, was there an EOB that um that was sent out?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Let's see if I have.
[CUSTOMER][NEUTRAL] Because I have one that says duplicate but maybe it's on there.
[CUSTOMER][NEUTRAL] Was that [PII]?
[AGENT][NEGATIVE] No, the, the one that we sent in [PII] where we originally denied it, the one for [PII], um.
[AGENT][NEUTRAL] That was the duplicate.
[CUSTOMER][NEUTRAL] Says duplicate yeah.
[CUSTOMER][NEUTRAL] OK, could you send me the March on the April, oh my God, I can't speak today, the [PII] out.
[CUSTOMER][NEUTRAL] Um, either fax it or email it.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what's the fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alright, you should receive that in the next 10 minutes. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] Um, that was it. What was your name again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and just a um reference number if you have one.
[AGENT][NEUTRAL] It's just my name in today's date and time.
[CUSTOMER][POSITIVE] All right thank you you have a great day.
[AGENT][POSITIVE] Thank you for calling APO. You have a great day as well.
[CUSTOMER][POSITIVE] Thanks. Bye bye.