AccountId: 011433970860
ContactId: 5e4f8234-1e50-44bf-9ee4-d4071dff8b9c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 266839 ms
Total Talk Time (AGENT): 84003 ms
Total Talk Time (CUSTOMER): 109879 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/5e4f8234-1e50-44bf-9ee4-d4071dff8b9c_20250211T15:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi. I'm [PII] from provider's office of Norton Care Centers for claim status.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with claim status. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] That's for sure. It's [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Policy number 02449775.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patients named [PII]. Their of birth, [PII].
[AGENT][NEUTRAL] Thank you. Now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] Yeah, so it's [PII] for $320 even.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, thanks for your patience. Um, we received that claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] The claim number is 3547835.
[AGENT][NEUTRAL] And the claim paid out for $60 even.
[AGENT][NEUTRAL] And it was a single check, and I have the check number here if you need that.
[CUSTOMER][NEUTRAL] Um, I just have the payment information. So, thanks for providing me. I just wanna know whether you guys cross the claim as primary or secondary.
[AGENT][NEUTRAL] Secondary.
[CUSTOMER][NEUTRAL] Secondary. All right, thank you. So, one moment, please.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So, for my clarification, so for 99213, you have been paid for $17.25. Am I correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And how about the remaining balance of $42.75?
[AGENT][NEUTRAL] Patient responsibility.
[CUSTOMER][NEUTRAL] What type of patient responsibility, co-pay or deductible?
[AGENT][NEUTRAL] Well, we're showing that those were non-covered charges by the primary insurance. So if the primary insurance doesn't cover a charge, we don't cover it either.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] But they process the claim completely and the co-pay of $60 for that particular call. And so we build to
[CUSTOMER][NEUTRAL] Secondary. So out of that, you guys allowed certain amount and denied the claim is not covered, but primary didn't denied the non-covered charges.
[AGENT][NEUTRAL] Yes, sir. If the primary doesn't cover it, then we don't cover it either.
[CUSTOMER][NEUTRAL] Even they process that co-payment?
[CUSTOMER][NEGATIVE] They don't deny it that's not covered. They just process as co-insurance, sorry, co-payment.
[AGENT][NEUTRAL] Well, that was the $60 and that's the portion that we paid. The other portion was covered by the primary insurance.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] All right. So you guys pay only the $60 of copay and the other amount is not processing, they have been denied it, correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] $64.26 is not covered due to primary denied that claim. All right. Thank you for letting me know. And could I get the call reference number, please?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. My name is [PII]. It's spelled [PII] My last initial is [PII] and today's date. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] No, I'm down for the day. Take care bye bye.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a great day as well. Mm bye.
[CUSTOMER][NEUTRAL] Mhm.