AccountId: 011433970860
ContactId: 528816cf-cf64-4083-bec3-5885debe95e3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 308380 ms
Total Talk Time (AGENT): 107908 ms
Total Talk Time (CUSTOMER): 74517 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/528816cf-cf64-4083-bec3-5885debe95e3_20250321T14:26_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from the provider's office and I'm calling for claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII]. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, member's policy number is 01265685.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, member's first name is [PII], last name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, data service is November 13224 and total bill amount is $242 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yes, provider's office name is Our Lady of the Lake Physician Group.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, sure, take your time.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] No, that's 11:13.
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Where did I get the 20 242, OK.
[AGENT][NEUTRAL] Is that the 11366.
[AGENT][NEUTRAL] OK, let's try that
[AGENT][NEUTRAL] Here it is.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So, the claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3551889.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim a total of $6.02.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And did you need the check information?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, actually, um, there was 2 CPTs on this claim and one was paid and one was denied, right?
[AGENT][NEGATIVE] Yes, code 99214 was denied because office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Is it not good.
[CUSTOMER][NEUTRAL] Oh let's see.
[CUSTOMER][NEUTRAL] OK, alright, so this is going to be members responsibility, right?
[AGENT][NEUTRAL] Also, since we are not a major medical insurance company, we don't determine patient responsibility, so that would be up to the provider and primary insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright, that's all I needed and I get a call reference.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Mhm. All right, [PII], by the way, [PII], what is the timely filing limit to send a fresh claim just for documentation purposes?
[AGENT][NEUTRAL] Um, there's no timely file limit as long as the policy is active on the data service, you can file at any time.
[CUSTOMER][POSITIVE] Alright and uh thank you so much for your help. I hope you have a great rest of your day and a wonderful weekend.
[AGENT][POSITIVE] Thank you, [PII]. You also thanks for calling APL. Have a great weekend. Bye-bye.