AccountId: 011433970860
ContactId: 6a4c0f7f-2d3b-4f08-92fe-f6a9e8d64e3b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 489500 ms
Total Talk Time (AGENT): 160835 ms
Total Talk Time (CUSTOMER): 195304 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/6a4c0f7f-2d3b-4f08-92fe-f6a9e8d64e3b_20250115T21:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi [PII]. My name is, uh, [PII], and I'm calling for the facility Blueel Medical Group LLC. Please be informed that this call being recorded on money for quality purposes regarding your claim status.
[AGENT][NEUTRAL] OK, I can help you, uh, [PII], what's the policy number?
[CUSTOMER][NEUTRAL] Sure, definitely. The policy number is 021.
[CUSTOMER][NEUTRAL] 82458
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. Can you verify the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Sure, definitely. The patient's name is [PII]. The date of birth is [PII].
[AGENT][POSITIVE] OK, thank you for that information.
[AGENT][NEUTRAL] And you said that you're checking for claim status?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Exactly right, yeah.
[AGENT][NEUTRAL] OK, what would be the date of service and the bill amount?
[CUSTOMER][NEUTRAL] [PII] for 20 $1,087.40.
[AGENT][NEUTRAL] Just for office visit and some diagnostic tests.
[CUSTOMER][POSITIVE] Uh, exactly, yep.
[AGENT][NEUTRAL] Oh, OK, one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] So I show the claim was received [PII], processed [PII].
[AGENT][NEUTRAL] The office visit benefit is not covered by the policy and then the treatment codes look like they applied towards the calendar year deductible on the under the APL policy.
[CUSTOMER][NEUTRAL] OK, if you don't mind, the office visit uh 99 uh 1 moment please. 99203 is not covered under the patient's policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All under the patient policy and the CPC code is not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, one moment if you don't mind. And may I know what kind of plan patient have?
[AGENT][NEUTRAL] This is this is a Metlink policy and it's more so the the um the place of service versus the procedure code that's not covered.
[CUSTOMER][NEUTRAL] Uh, actually, in a sense, uh, the issues between the CPT code and place of service or the CP, the office is not covered under the patient's policy.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] There are 2 types of there.
[CUSTOMER][NEUTRAL] Which one is uh valid uh
[AGENT][NEGATIVE] Well, it's the place of service that's not covered.
[CUSTOMER][NEUTRAL] Oh, place of service, uh, is not covered, uh, for the C code 99203, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, not couple of both. OK, thank you so much, and one moment if you don't mind.
[CUSTOMER][NEUTRAL] OK, may I know the claim number?
[AGENT][NEUTRAL] 347.
[AGENT][NEUTRAL] 1061.
[AGENT][NEUTRAL] And [PII], you can also check your status online at secured.
[CUSTOMER][NEUTRAL] If you don't mind.
[CUSTOMER][NEUTRAL] Yeah, actually, what is the amount for the all other CPT codes, uh, it was applied to the deductible.
[AGENT][NEUTRAL] And you'll have to verify that from the primary ELB that was submitted with the claim.
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] It is $156.47 for the both codes was applied to the deductible, right?
[AGENT][NEUTRAL] OK, whatever amount is listed on the primary explanation of benefits under that column is what was applied towards your deductible.
[CUSTOMER][NEUTRAL] So the out of network deductible, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] It's out of network deductible, right?
[AGENT][NEUTRAL] Uh, you'll have to look at the primary EOB for that information. What I'm saying is when we process the claim, APL has a deductible as well, so it was applied towards the APL deductible.
[CUSTOMER][NEUTRAL] Yeah, that's what I'm asking. Uh, the other two CPT codes you guys are applied $156.47 as a deductible, right?
[AGENT][NEUTRAL] OK, so for procedure code 76881881, do you have a copy of the primary EOB in front of you?
[CUSTOMER][NEUTRAL] What is the code 73564, right?
[AGENT][NEUTRAL] Uh, that's one of them.
[CUSTOMER][NEUTRAL] OK. The CPT code is 73564. What is the deductible amount?
[CUSTOMER][NEUTRAL] Is it for $45.13 the leftover, Medicare leftover.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And OK. And the CPT code uh 76881, the Medicaid leftover uh $111.34 and you guys are the same thing, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And you guys are process is out of network deductable as well, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Shall I verify the patient's account number or control number if you don't mind?
[AGENT][NEUTRAL] The account number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what account number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm not sure what account number that is.
[CUSTOMER][NEUTRAL] OK mm.
[CUSTOMER][NEUTRAL] What is the annual deductible amount for this member?
[AGENT][NEUTRAL] $1000 per calendar year.
[CUSTOMER][NEUTRAL] $2000 now no matter how much made so far.
[AGENT][NEUTRAL] It's $1000 per calendar year.
[AGENT][NEUTRAL] Let me check to see what amount has been used or met.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So for the [PII] year I'm showing $462.74 has been satisfied of that $1000 deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, so the amount is $1000. The memo is $462.74 right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Thank you. What is the mailing address the year we were sent to the provider? Which mailing addres[PII]?
[AGENT][NEUTRAL] If you can verify the address on the claim, I can confirm.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, that's where it was mailed.
[CUSTOMER][NEUTRAL] OK, and we will send the mail, mailing address on uh [PII] still fine.
[AGENT][NEUTRAL] So it processed on the [PII], the explanation would have mailed out the next business day.
[CUSTOMER][NEUTRAL] [PII]. OK. Thank you. And could you please fax or email that we do the same email address, please?
[AGENT][NEUTRAL] Yeah as I was stating earlier, you can download it from our online service center at [PII], and I can help you set that account up and download the explanation of benefits.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. OK, thank you for your reference number, please.
[AGENT][NEUTRAL] My name and today's date, [PII], first initial last name is [PII], do you want me to help you create the account?
[CUSTOMER][POSITIVE] All right, thank you so much. I'll just check with my team. Thank you. Have a wonderful day. Bye-bye.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too