AccountId: 011433970860
ContactId: 5f61b6ab-71bd-40bd-8fe2-875a2719717c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 719200 ms
Total Talk Time (AGENT): 252428 ms
Total Talk Time (CUSTOMER): 241014 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/5f61b6ab-71bd-40bd-8fe2-875a2719717c_20250409T19:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on our client status.
[AGENT][NEUTRAL] OK, I could check on a claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] with [PII] [PII].
[AGENT][NEUTRAL] Thank you. And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, it's D as in Delta 43732467.
[AGENT][NEUTRAL] OK, so that's not one of our policy numbers [PII] that is through, uh, they're called 90 degree benefits. Um, I can give you their information and transfer you to them if you'd like, um, or if you've got their social, I can see if they have any claims with us.
[CUSTOMER][NEUTRAL] OK, so that's
[CUSTOMER][NEUTRAL] Um, I have.
[CUSTOMER][NEUTRAL] Yeah, I have the Social Security number. Can I give that one?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] Uh, what was the name for the member?
[CUSTOMER][NEUTRAL] The name, patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. I did find a policy with us. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the bill amount is.
[CUSTOMER][NEUTRAL] $318 even.
[AGENT][NEUTRAL] OK, and that was you said 12 of 25, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] later.
[AGENT][NEUTRAL] Do you have the uh tax ID for this provider's office, [PII]?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] OK, thank you for that one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that bill them out that what you said $318 correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I don't see a claim for that specific amount from this provider for the state of service. I do have a claim for $312.
[CUSTOMER][NEUTRAL] Oh, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, sorry, let me check.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Was this claim just for one procedure code [PII], or were there multiple?
[CUSTOMER][NEUTRAL] Uh, uh, it's under the bill with the 3 CPT codes. I'm having the build amount. You're having the build amount of 318.
[AGENT][NEUTRAL] 3.
[AGENT][NEUTRAL] OK, I do have one claim for 3, CPT codes or excuse me, three procedure codes, um, was that 721257 and then two instances of 71046, is that correct?
[CUSTOMER][POSITIVE] OK thank you.
[CUSTOMER][NEUTRAL] Yes, 72 and 7, yes, 7127572128.
[CUSTOMER][NEUTRAL] And another 1, 70,450.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] 72128.
[AGENT][NEUTRAL] Oh, that's gonna be a different one. OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Sorry, we did receive several claims for the state of service.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, sorry.
[AGENT][NEUTRAL] No, no, no, that's perfectly fine. OK, so it was 2 CPT codes.
[CUSTOMER][NEUTRAL] OK fine.
[CUSTOMER][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] OK, OK. So I did find it. Sorry about that confusion. All right, give me just a moment. Let me take a look here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so yes, we did receive this claim. We were unable to pay a benefit as their calendar year maximum on diagnostic services had been met.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] It's under the patient responsibility.
[AGENT][NEUTRAL] We do not say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, OK. The CPT code, uh, how many units are allowed, all 3 CPT codes?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Uh, the CPT code, how many units are allowed?
[AGENT][NEUTRAL] For diagnostic tests.
[CUSTOMER][NEUTRAL] Yes. How many units are allowed?
[AGENT][NEUTRAL] Oh, let me check that frequency. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I think they're allowed one diagnostic test uh per calendar year if I'm.
[AGENT][NEUTRAL] Remember that right. Let me, give me just a moment. I'm gonna get the policy pulled up to double check that.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yes, um, I'm so sorry about that wait. So yes, it is the one diagnostic test it would pay up to $250 per test.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, OK, so it's not under the patient responsibility, is it correct?
[AGENT][NEUTRAL] We do not say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] We didn't
[CUSTOMER][POSITIVE] Yeah, OK. Thank you so much. I have another client. Can I go with the next one?
[AGENT][NEUTRAL] Is this for the same member?
[CUSTOMER][NEUTRAL] No, it's for a different member.
[AGENT][NEUTRAL] OK, give me just a moment. I'll let you know when I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] OK, and did you need any other information regarding this claim, [PII]?
[CUSTOMER][NEGATIVE] Some issues
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] All right. You can go ahead with that next policy number.
[CUSTOMER][NEUTRAL] It's D as in Delta 43,728,250.
[AGENT][NEUTRAL] OK, so again, that's not one of our policy numbers, [PII]. Um, that is through 90 degree benefits. So if you have their social, I could search for them that way.
[CUSTOMER][NEUTRAL] Can I give the patient's SSN number? Yeah, I have the social number. It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK and then uh what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What was the name and date of birth for this number, please?
[CUSTOMER][NEUTRAL] Uh, the patient's name is [PII], and the first name is [PII].
[AGENT][NEUTRAL] OK, so I did not get that result with this with the uh social security number. I'm gonna read that back to make sure I heard it correctly. That was [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Security number
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm sorry, it cut out there, [PII]. What was that?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] [PII]. OK. Sorry about that. One moment.
[CUSTOMER][NEUTRAL] I that
[CUSTOMER][NEUTRAL] Pool.
[AGENT][NEUTRAL] Um, what was the date of birth for this number?
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. What was the date of service for this claim?
[CUSTOMER][POSITIVE] OK thank you
[CUSTOMER][NEUTRAL] On the date of service [PII] with the bill amount $146.
[AGENT][NEUTRAL] I'm sorry, [PII], it's, it's really cutting out. Uh, could you repeat that date of service and the bill amount please?
[CUSTOMER][NEUTRAL] It's.
[CUSTOMER][NEUTRAL] [PII] with the bill amount $146 even.
[AGENT][NEUTRAL] 146. OK, so this policy I'm showing terminated, uh, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see, and he did not have another active policy. Um, even so, I'm not showing that we received any claims for this policy at all. So we didn't receive that one.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Yeah. OK. Thank you so much. And can I get the call? I have the claim number.
[AGENT][NEUTRAL] OK, go ahead. What was that claim number?
[CUSTOMER][NEUTRAL] I see a number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The claim number 5386668.
[AGENT][NEUTRAL] Could you repeat that, [PII]? I'm sorry.
[CUSTOMER][NEUTRAL] 353-866-8
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, uh, so that was for his, uh, disability policy.
[CUSTOMER][NEUTRAL] OK, thank you so much. So the patient is not active for the date of service, which is [PII] is the date of service. So the patient is not active for the date of service.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yeah, OK. Thank you so much. And can I get the call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. My name is spelled [PII] Was there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] Yeah, your name?
[CUSTOMER][POSITIVE] Yeah, thank you, thank you so much. That's for, thank you so much for your patience and help. Have a great day.
[AGENT][POSITIVE] Of course, thank you for calling APL.
[AGENT][POSITIVE] You too thank you bye bye.
[CUSTOMER][NEUTRAL] OK