AccountId: 011433970860
ContactId: 75b348c2-4320-4fbd-beda-3107d18b4643
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 772200 ms
Total Talk Time (AGENT): 137832 ms
Total Talk Time (CUSTOMER): 436262 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/75b348c2-4320-4fbd-beda-3107d18b4643_20250410T17:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh hi [PII]. My name is [PII]. I'm calling for a provider to check on a claim status. Please be informed that this call is being recorded, monitored for quality and training purposes, and [PII], I'm calling for the facility that is um.
[CUSTOMER][NEUTRAL] Fritz Jenning Clinic.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a policy number for the patient?
[CUSTOMER][NEUTRAL] Uh, yes, I do have the policy number is I'm sorry, I'm calling for a clarification. I'm sorry for that. The member ID that is um D as in David 404005.
[CUSTOMER][NEUTRAL] 33
[AGENT][NEUTRAL] And the last name of the patient?
[CUSTOMER][NEUTRAL] Sure. The last name is um that is, let me just spell it out. That is [PII].
[CUSTOMER][NEUTRAL] They don't
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have a good callback number?
[CUSTOMER][NEUTRAL] Sure, the callback number that is [PII] without the extension is a direct line.
[AGENT][NEUTRAL] OK, thank you. And the first name of the patient?
[CUSTOMER][NEUTRAL] Sure. The first name, that is.
[CUSTOMER][NEUTRAL] Um, I think I provide you the incorrect, you know, name.
[CUSTOMER][NEUTRAL] The last name is the one which I provide you [PII]. That is the first name. My apologize for that. And the last name that is [PII], and date of birth is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] Oh yes hi my name is [PII]. I'm calling from provider [PII].
[AGENT][NEUTRAL] Is this for a medical?
[CUSTOMER][NEUTRAL] Um, allow me a moment, let me just check for medical.
[CUSTOMER][NEUTRAL] So for yes, it's for medical.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I instructions.
[CUSTOMER][NEUTRAL] And the name is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. What was that birthday again?
[CUSTOMER][NEUTRAL] Uh, the birth date is [PII].
[AGENT][NEUTRAL] OK, thank you. And then what was the date of service?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure, the date of service I'm looking for that is um [PII], the billing amount of $309 even.
[CUSTOMER][NEUTRAL] Uh, may I just have the claim number.
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] Alright, give me one moment.
[CUSTOMER][NEUTRAL] Uh sure.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEUTRAL] OK, I'm sorry, what was that bill amount again?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Sure, the billing amount that is 309309.
[AGENT][NEUTRAL] Oh, sorry.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Um, OK, so
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it looks like.
[CUSTOMER][NEUTRAL] So then he checks where they check or if they may get the.
[AGENT][NEUTRAL] Uh, that claim was received on 11-21-2024, paid on [PII].
[CUSTOMER][NEUTRAL] or just
[AGENT][NEUTRAL] And we made a payment of $50.
[CUSTOMER][NEUTRAL] OK, OK, so I do have that information. The one which you pay that $50 and there is an outstanding amount of, uh, so may I know what about the CPG card J1885 and [PII]. I just, I do see that you're not paying that that CPG card.
[AGENT][NEUTRAL] Yeah, so this is a limited supplemental plan, so the max payout for an office visit is $50.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] mailing address. So that means like the patients has uh you know exit the maximum service or as per as per um
[AGENT][NEUTRAL] Yeah, $50 is.
[AGENT][NEUTRAL] $50 is the most that it will pay for this, uh, service.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, allow me a moment. So you mean that per per service you pay only $50.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So that means they, you know, they, they exceeded as per dollar, right?
[CUSTOMER][NEGATIVE] Uh, just before I refunded it.
[AGENT][NEUTRAL] There's a $50 maximum payout for office visits. So that's all it's gonna pay on this claim.
[CUSTOMER][NEUTRAL] Could you repeat, uh, repeat.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] I mean the way you just could you please repeat that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Allow me one moment.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And is it possible if you could help me with this this one? I just want to verify if if you have a patient control number account number or no information on.
[CUSTOMER][NEUTRAL] OK, so may I know, do you have any information? When was the last service bill? I know when was the last service pill?
[AGENT][NEUTRAL] When was the what?
[AGENT][NEUTRAL] I, I don't understand the question, so this the claim was for you billed us for the [PII]?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK, after that, is there any service bill?
[AGENT][NEUTRAL] Is there any service bill?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Like a claim from you or what do you mean?
[CUSTOMER][NEUTRAL] Yes, uh, means like from, from the from the like, yes, it's from us. When was the last service built for this patient?
[AGENT][NEUTRAL] Well, I, I gave you the, when you sent the claim, it was.
[AGENT][NEUTRAL] [PII] and that was processed on [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, thank you so much for for you. May I know, do you have any information like for the time period to build the service?
[AGENT][NEUTRAL] The timely filing?
[CUSTOMER][NEUTRAL] so
[CUSTOMER][NEUTRAL] No time period. Do you have any time period? Do you have any specific time period to build the service?
[AGENT][NEUTRAL] No, there's no time period, no.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you so much. So I just need for documentation purpose, can you please provide me your family family limit to submitted corrected claims.
[AGENT][NEGATIVE] There's there's no timely filing.
[CUSTOMER][NEUTRAL] OK, thank you. Can you please provide me your billing address to submit and correct the claims.
[AGENT][NEUTRAL] Billing address is [PII].
[CUSTOMER][NEUTRAL] From
[CUSTOMER][NEUTRAL] Thank you so much for your information. So may I know, do you have any appeal mailing address and any appeal uh appeal family find any email?
[AGENT][NEUTRAL] 180 days from the process date is the appeal. We do have some duplicate claims that were sent in, so you've sent in duplicate claims, but they were denied as duplicates.
[CUSTOMER][NEUTRAL] OK uh.
[CUSTOMER][NEUTRAL] Uh, I just need for documentation purpose, so.
[CUSTOMER][POSITIVE] Thank you so much. Can you please provide me the duplicate claim receive stage as well, please?
[AGENT][NEUTRAL] That is
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEGATIVE] I was received [PII] and denied [PII].
[CUSTOMER][NEUTRAL] OK, thank you so much for your information. So [PII], can you please provide me your a bill mailing address as well, please, and a bill attention and any specific form for a bill.
[AGENT][NEUTRAL] It's the same mailing address as our claims.
[AGENT][NEUTRAL] And no, there's no attention.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you don't have any, do you have any specific form?
[AGENT][NEGATIVE] No, there's no form.
[CUSTOMER][POSITIVE] OK, thank you so so much for your information. Just allow me one moment. I do see that um.
[CUSTOMER][NEUTRAL] Let me just verify the claim. I just see that the, the claim number that is 3534303. Is that correct?
[AGENT][POSITIVE] Yes, that's right.
[CUSTOMER][POSITIVE] Thank you so much for your information and I just need for the documentation purpose, may not require denied EOP for the submission.
[AGENT][NEUTRAL] Um, no, we don't.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][POSITIVE] OK. Thank you so much for your information. So let me just verify, I'm sorry for your your, mm.
[CUSTOMER][NEUTRAL] Your claim status [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much. Can you please allow me 111 moment please. allow me one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. Can you please, thank you.
[CUSTOMER][POSITIVE] Thank you so much [PII]. I appreciate it.
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] Um, hello, uh, [PII], let me just ask you one more question. The one which like, uh, the claims denied that to both the CPT code you stating that 50 maximum payout for the office visits, so that means the patients had um exit the service, right?
[AGENT][NEUTRAL] Yes, I'm here.
[AGENT][NEUTRAL] The patient has what?
[CUSTOMER][NEUTRAL] The patient has uh you know Max the service, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much. Can you please provide me the reference number?
[AGENT][NEUTRAL] A call reference number is just my name, [PII], first initial to last name, [PII], and today's date.
[CUSTOMER][POSITIVE] All right, thank you so much. I appreciate your assistance. Have a wonderful day here. Thank you. Bye now.
[AGENT][POSITIVE] Thank you for calling. Have a good day. Bye.