AccountId: 011433970860
ContactId: 6be2ef26-2a2c-49f9-bf53-98c8408f5707
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 414579 ms
Total Talk Time (AGENT): 153046 ms
Total Talk Time (CUSTOMER): 168276 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/6be2ef26-2a2c-49f9-bf53-98c8408f5707_20250129T16:10_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office. How are you doing today?
[AGENT][POSITIVE] I'm good. Can you spell your first name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, and you said that you're calling for a claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] 02274045.
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh patient first name is [PII] and last name is [PII], and date of birth, [PII].
[AGENT][NEUTRAL] OK, thanks for verifying that information, [PII], and you said that you're checking claim status. uh, what's the date of service?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, repeat the month again.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] and the total bill?
[CUSTOMER][NEUTRAL] Uh, total bill is going to be $895.06.
[AGENT][NEUTRAL] 895.06. Is this a dental claim or medical?
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] OK, so the policy number you gave me is for dental. Let me give you the medical policy number.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's actually um all the numbers are the same except the last digit instead of a 5 it's 2, so 4042.
[CUSTOMER][NEUTRAL] 02274045.
[AGENT][NEUTRAL] The correct policy number is 2274042. The one you gave me is for a dental policy, not medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I export
[CUSTOMER][NEUTRAL] 02274042 is that correct?
[AGENT][POSITIVE] Correct. Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the uh procedure codes on the claim for me, please?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] eBay.
[CUSTOMER][NEUTRAL] 99386.
[CUSTOMER][NEUTRAL] G 04449949796156.
[CUSTOMER][NEUTRAL] 1159 F.
[AGENT][POSITIVE] OK, thank
[AGENT][POSITIVE] OK, I have it. Thank you.
[AGENT][NEUTRAL] So this claim was received [PII], processed [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 25.
[CUSTOMER][NEUTRAL] What's that?
[AGENT][NEUTRAL] Um, issuing a payment of.
[AGENT][NEUTRAL] $75.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, I'm finished.
[AGENT][NEUTRAL] And that would be the calendar year maximum for this type of service.
[CUSTOMER][NEUTRAL] OK. 499386.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] What number is that?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] 99386.
[CUSTOMER][NEUTRAL] Pay month.
[AGENT][NEUTRAL] $75 is the paid amount.
[CUSTOMER][NEUTRAL] Total pay amount $75.
[AGENT][NEUTRAL] 75 $75.
[AGENT][NEUTRAL] Which is the maximum per visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yep
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] There is no patient responsibility against the C code.
[AGENT][NEUTRAL] Yeah, APL does not determine patients responsibility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and you can also check claim status on our online service center at [PII]. And did you have any other questions, [PII], I can help with today?
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yes, 30444. What's the status for the CPD code?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] G 0444.
[CUSTOMER][NEUTRAL] What's the status of this?
[AGENT][NEUTRAL] OK, what is that number?
[AGENT][NEUTRAL] OK, I'm not understanding your question.
[CUSTOMER][NEUTRAL] Mhm go ahead.
[CUSTOMER][NEUTRAL] I just want to confirm uh G0444 is that paid or denied CPT code.
[AGENT][NEUTRAL] The only the only code that was paid is the 99497.
[AGENT][NEGATIVE] Everything else was not payable because the maximum was paid.
[AGENT][NEUTRAL] On the 99497 code.
[CUSTOMER][NEUTRAL] OK, and uh what's the normal reason for uh other CPT code.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] 99386 is denied.
[AGENT][NEGATIVE] The only code that was paid was the 99497. All of the other codes were denied because the maximum benefit is met.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, what is the claim number?
[AGENT][NEUTRAL] 355.
[AGENT][NEUTRAL] 0617.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] That's the claim number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 355-0617.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And uh uh can you repeat, can you repeat one more time denial reason.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] $75 is the maximum per visit.
[AGENT][NEGATIVE] So 75 was paid on the code that was provided. The other charges were denied because the maximum benefit is met. It's exhausted.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can I have your name?
[AGENT][NEUTRAL] You'll use my name in today's date as reference for today's call [PII].
[CUSTOMER][NEUTRAL] Like
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] First initial of my last name is [PII] and [PII], any other questions?
[CUSTOMER][NEGATIVE] No thank you.
[AGENT][POSITIVE] You're welcome thank you for calling APL have a good day.
[CUSTOMER][POSITIVE] Wonderful day thank you.
[CUSTOMER][NEUTRAL] I was like out of like.