AccountId: 011433970860
ContactId: 7383f0f2-7b91-425d-a68b-e15344e59cc2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 586650 ms
Total Talk Time (AGENT): 153658 ms
Total Talk Time (CUSTOMER): 108032 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/7383f0f2-7b91-425d-a68b-e15344e59cc2_20250606T14:24_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from the provider's office to check on a claim status.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status. And how do you spell your name?
[CUSTOMER][NEUTRAL] It's spelled as [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have a callback number just in case we get disconnected Miss [PII]?
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII] with the extension of [PII]. Could you please spell out your name for me, please?
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Sure. That's [PII].
[AGENT][NEUTRAL] And may I have the uh the name of the facility you're calling from for my notes?
[CUSTOMER][NEUTRAL] Yeah, sure. It's Next Step Foot and Ankle Center.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. The member ID is 0, I'm sorry, 01660281 M as in Mike, L as in Lima 8.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, sure. The member's name is [PII] and the last name is [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] Perfect thank you and may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes, sure. The date of service is [PII] and the total bill amount is $342.36.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right, let me go ahead and see if I can find it. And for future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] What is the procedure code, Miss [PII]?
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's 99214.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let me pull the original claim. This claim was processed 4 times. The last 3 times has been processed as a duplicate, so let me go ahead and give you information about the original claim. OK, one moment.
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, so it looks like the original claim was let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see when it was received. OK, let's see.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] 282
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so it looks like the claim was received back on [PII], processed [PII], and it was denied stating that office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK. Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Be more than
[CUSTOMER][NEUTRAL] So, may I know which guidelines you are following?
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Uh, is there any specific guidelines?
[AGENT][NEUTRAL] No. On this policy, it's a secondary policy to the major medical and office visits are not covered under the member's plan.
[CUSTOMER][NEUTRAL] Just
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] Uh, just a minute, so my system is hanging just.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This is.
[CUSTOMER][POSITIVE] OK. Thank you so much for holding, sir.
[AGENT][POSITIVE] You're welcome. Yes.
[CUSTOMER][NEUTRAL] Yeah, I'm just checking the previous one here it shows us downloading.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, could you please confirm the credit claim timely filing limits?
[AGENT][NEUTRAL] OK, we don't have timely filing limits for claim submissions.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Now, again, Ms. [PII], just keep in mind that we have received this claim 4 times. 3 times has been denied as a duplicate and 1 time was denied correctly indicating that office visits are not covered under the member's plan, OK?
[CUSTOMER][NEUTRAL] OK, so could you please suggest me uh what we can do in this situation?
[AGENT][NEUTRAL] It's up to the provider's discretion.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] It's up to the provider's discretion what they wanna do with the remaining balance.
[CUSTOMER][NEUTRAL] OK. So could you please confirm uh the number?
[AGENT][NEGATIVE] Mhm. It's just not covered by us.
[CUSTOMER][NEUTRAL] OK. Could you please confirm the number plan type?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][POSITIVE] Thank you so much. Can I get the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][POSITIVE] No, there is none. Thank you so much for your kind assistance. Have a nice day. Bye.
[AGENT][POSITIVE] You as well thank you for calling APL bye bye.