AccountId: 011433970860
ContactId: 60930b2d-a74e-454b-b5f0-ea913f127538
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259260 ms
Total Talk Time (AGENT): 90388 ms
Total Talk Time (CUSTOMER): 109815 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/60930b2d-a74e-454b-b5f0-ea913f127538_20250325T19:15_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Yes, good afternoon, I'm calling from provider's office and I just need claims please.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status. May I have your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and I need the name of the facility you're calling from and a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] Cardiology consult on Southwest Broward and it's [PII].
[AGENT][NEUTRAL] OK. And do you have the policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] It's 21,000.
[CUSTOMER][NEUTRAL] Well, I'm OK, let me get the policy number from EOB. It's 01655031.
[AGENT][NEUTRAL] Um, what's the name of the patient?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII] hm.
[AGENT][NEUTRAL] OK, so that was the policy number 65021 is the policy number.
[AGENT][NEUTRAL] OK, and see what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] OK, the first day the service is uh.
[CUSTOMER][NEUTRAL] Uh, 12125, uh, total charges.
[CUSTOMER][NEUTRAL] I'm gonna look on it OK.
[CUSTOMER][NEUTRAL] I'm not sure if it's if it's uh applied to deductibles. I'm just gonna verify that total charge $235.
[AGENT][NEUTRAL] OK. All right. And that was [PII].
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] What are the procedure codes?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so it was processed twice. The most recent one was processed as a duplicate. So I'm gonna give you the original information, OK? One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, good good.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, I'm waiting on the EOB one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] It doesn't really specify just says uh mark one and it's a duplicate bill.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] Our patience for this has been missed.
[AGENT][NEUTRAL] OK. So the original one was processed on [PII] and it was denied. There are two denial reasons. Office visits are not covered by the policy and outpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK sir, so it applied to the patient responsibility then.
[AGENT][NEGATIVE] It was just not covered. We're not a major medical. We're a secondary policy, so it's just denied. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, but didn't, OK, so didn't think it wasn't there a crossover from his primary United Healthcare?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You didn't get, you didn't get the one with the original with the.
[CUSTOMER][NEUTRAL] Primary insurance.
[AGENT][NEGATIVE] We did get all the information we needed to process, but we did process and decided that we denied claim because of visit are not covered and because the member already exhausted the benefit for the year, so it's just denied by us, mhm.
[CUSTOMER][NEUTRAL] We did get all the information.
[CUSTOMER][POSITIVE] OK, I got you.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] I got you. Alright, that's all I need to know. Thank you very much you have a good day, OK?
[AGENT][NEUTRAL] OK. You as well. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] No, that's it thank you bye bye.
[AGENT][POSITIVE] You're welcome, Mr. [PII]. Thank you for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] Bye.