AccountId: 011433970860
ContactId: 6532d2a3-bc2b-4e6f-94b8-617b7090d09a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 657280 ms
Total Talk Time (AGENT): 199313 ms
Total Talk Time (CUSTOMER): 156467 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/6532d2a3-bc2b-4e6f-94b8-617b7090d09a_20250113T15:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling AP. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII] here calling from provider's office to check on claim status.
[AGENT][NEUTRAL] OK, I didn't understand your name. Can you spell it for me?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, and you said you're checking claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] Before you proceed, I'll let you know this call will be recorded for quality and training purpose and the member ID number is 02221656. [PII].
[AGENT][NEUTRAL] OK, and what's your phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you, give me one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] I'm pulling up the file.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for that information and I can assist you with the claim status. What's the date of service and the charge?
[CUSTOMER][NEUTRAL] [PII] and the amount is 1000.
[CUSTOMER][NEUTRAL] $19 even 1019.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the procedure code on the claim?
[CUSTOMER][NEUTRAL] 76817.
[CUSTOMER][NEUTRAL] 76816, 76819.
[AGENT][NEGATIVE] OK, you cut out on me. Can you repeat the, um, procedure code?
[CUSTOMER][NEUTRAL] 76817.
[AGENT][NEUTRAL] And is the total charge, you said it's $119?
[CUSTOMER][NEUTRAL] Yes, there are 3 separate codes.
[AGENT][NEUTRAL] OK, so I'm not showing that to be the total charge. Do you have a copy of the claim?
[CUSTOMER][NEUTRAL] Mm, yes, I have primary UB.
[AGENT][NEUTRAL] What's the total bill charge?
[CUSTOMER][NEUTRAL] OK, I'll check the email. 30 seconds.
[CUSTOMER][NEUTRAL] Yeah, it's 1019.
[AGENT][NEUTRAL] OK, 1019. OK.
[CUSTOMER][NEUTRAL] And also.
[AGENT][NEUTRAL] So I'm showing that the claim uh was not payable, the maximum outpatient benefit.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Of $3500 per calendar year was exhausted.
[AGENT][NEUTRAL] I'm showing that this claim was received [PII].
[AGENT][NEUTRAL] Process [PII] and the explanation of benefits was mailed to the address that's on the claim. Um I do have the claim number, let me know when you're ready.
[CUSTOMER][NEUTRAL] Yeah, yeah, insurance claim is renowned for the primary will be correct.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Claim is denied for the primary UP correct?
[AGENT][NEUTRAL] Are you asking if the claim was denied by the primary?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, do you have a copy of the primary explanation of benefits?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And so does it show denied?
[CUSTOMER][NEUTRAL] No, I'm asking you, uh, secondary, uh, insurance is denied or not.
[AGENT][NEUTRAL] Oh, I said that there was no payment made because the maximum outpatient benefit is exhausted, so no payment was made.
[AGENT][NEUTRAL] You can also check your status on our our online service center at [PII] and [PII], did you have any other questions?
[CUSTOMER][NEUTRAL] OK. Could you please provide the claim number?
[AGENT][NEUTRAL] That claim number is 353-6003.
[CUSTOMER][NEUTRAL] OK. Thank you so much. Uh, actually, I do have uh two more another claims for the same patient, but different service. So could you please help me with that also?
[AGENT][NEUTRAL] The date of service and the chart and give me them at the same time please.
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the amount is $750 even.
[AGENT][NEUTRAL] 750
[CUSTOMER][NEUTRAL] Yes, 750.
[AGENT][NEUTRAL] And the next one?
[CUSTOMER][NEUTRAL] And next one is.
[CUSTOMER][NEUTRAL] [PII]. And the amount is $200 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And both claims are denied for the primary UB. So you already sent the primary UB via fax. So now I want to know the status of that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the procedure code for the [PII] data service?
[CUSTOMER][NEUTRAL] 99232.
[AGENT][NEUTRAL] And the procedure code for the [PII] date of service?
[CUSTOMER][NEUTRAL] 768019 76813.
[AGENT][NEUTRAL] OK, so the maximum outpatient benefit was exhausted on this claim, so no payment was made. This is the [PII] date of service. I'm showing the claim number is 353.
[AGENT][NEUTRAL] 7996.
[AGENT][NEUTRAL] Received [PII].
[AGENT][NEUTRAL] Process [PII].
[AGENT][NEUTRAL] 24
[AGENT][NEUTRAL] And then moving to the [PII] data service.
[AGENT][NEUTRAL] Uh, this claim was received [PII].
[AGENT][NEUTRAL] Process [PII].
[AGENT][NEGATIVE] And I'm showing that it denied as a duplicate, which means we received the itemized bill only, not the primary EOB.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Could you please explain me again for data service [PII]?
[AGENT][NEUTRAL] You said that you submitted the primary explanation of benefits for that data service?
[CUSTOMER][NEUTRAL] OK. Yes.
[AGENT][NEUTRAL] OK, so the information that we received on [PII].
[AGENT][NEUTRAL] It's just the itemized bill. There is no primary EOB attached.
[AGENT][NEUTRAL] So we denied it as a duplicate.
[CUSTOMER][NEUTRAL] OK, so I need
[CUSTOMER][NEUTRAL] OK, so I need to resend again.
[AGENT][NEUTRAL] We have not received the EOB, so yeah, you can send that to us.
[CUSTOMER][NEUTRAL] And for
[CUSTOMER][NEUTRAL] [PII]. Uh, could you please repeat again?
[AGENT][NEUTRAL] The maximum outpatient benefit is exhausted, so there were no benefits available so that claim was not payable.
[CUSTOMER][POSITIVE] OK, thank you so much. Could you please uh provide me the call reference number and your name?
[AGENT][NEUTRAL] My name and today's date, [PII]
[AGENT][NEUTRAL] First initial of my last name is [PII]. Anything else I can assist with today?
[CUSTOMER][NEUTRAL] Uh, could you please repeat again your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, thank you so much. No, I'll done from myself.
[AGENT][POSITIVE] Alrighty thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Call reference number is your name and today's date, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you so much. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome thanks for calling APL have a good day.