AccountId: 011433970860
ContactId: 72f79bc2-439b-4367-aacd-44d3306d42a3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 451950 ms
Total Talk Time (AGENT): 189778 ms
Total Talk Time (CUSTOMER): 91023 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/72f79bc2-439b-4367-aacd-44d3306d42a3_20250103T16:18_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling you from provider's office, checking on claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status and you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII], it's the direct line.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 021-96790. M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII], uh sorry, I apologize. date of service is [PII]. Total charge $941 even.
[AGENT][NEUTRAL] OK. [PII] for 9:41, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, OK, let me see if I can find this claim and for future you can check claim status online through our website at [PII] and that's just optional and let's see.
[AGENT][NEUTRAL] Do you know what's the procedure code?
[CUSTOMER][NEUTRAL] Yeah, the procedure code is.
[CUSTOMER][NEUTRAL] 99214.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment, let me pull this up.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, it looks like we processed the claim [PII].
[AGENT][NEUTRAL] And we send a benefit amount of $79.70 to the provider. Um, the code 99214 was denied because office visits are not covered by the policy, and then there was another two denials, uh, 3079F and 3074F. Those two was also denied, and the reason for those are being denied is that let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, bear with me, I'm waiting on the system.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Policy does not provide benefits uh which no charges were occurred, so those two were also denied because there was no charges for those two. So the only ones that paid um was for 20612, which we pay $77.64 and um the J 3301 which we paid $2.06.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And uh how much was the allowed amount for that one?
[AGENT][NEUTRAL] The J code
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm, let me check with the major medical because we don't have a lot of amounts, that's just the major medical. Bear with me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so J code.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, they only apply $2.06 towards the member's responsibility.
[CUSTOMER][NEUTRAL] OK. And can I get the claim number?
[AGENT][NEUTRAL] So that is what we paid.
[AGENT][NEUTRAL] The claim number is going to be 3539907.
[CUSTOMER][NEUTRAL] 353-99007. I right?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] Just give me 1 2nd please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh may I know the mode of payment?
[AGENT][NEUTRAL] It is a check single check paper check.
[CUSTOMER][NEUTRAL] Yes, single check amount.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can I get the number, please?
[AGENT][NEUTRAL] The check number is 2486626. I'm sorry, that is the policy number. The check number is 2,017,890.
[CUSTOMER][NEUTRAL] OK. And when was that issued?
[AGENT][NEUTRAL] The same day that it was processed, which is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], so we need to allow more time, I'm right to get it cash. OK. Uh, can you please verify with the pay to address?
[AGENT][POSITIVE] Mhm. Correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh sure, yes, um, let me get that.
[AGENT][NEUTRAL] That was to [PII].
[CUSTOMER][NEUTRAL] OK. And uh can I get the claim receive date?
[AGENT][NEUTRAL] The received date. OK, bear with me. I need to check and see where it was received. It's not on the ELB.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] It was received [PII].
[CUSTOMER][NEUTRAL] OK, it was received [PII] and it was processed on [PII]. I'm right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And may I have your name spelled, please?
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sure, it was great speaking with you. Have a good day. Bye-bye.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day. bye-bye, Mr.
[CUSTOMER][NEUTRAL] Bye.