AccountId: 011433970860
ContactId: 77e9c0cf-c4d2-4a5c-ab6a-845ace61688b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 709369 ms
Total Talk Time (AGENT): 235856 ms
Total Talk Time (CUSTOMER): 293981 ms
Interruptions: 4
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/77e9c0cf-c4d2-4a5c-ab6a-845ace61688b_20241230T16:02_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from provider office, CS Anesthesia Partners of Texas, and I'm looking for the claim status today.
[AGENT][NEUTRAL] [PII], you have one claim that you're needing claim status on, is that correct?
[CUSTOMER][NEUTRAL] Uh yes. Uh, sorry, uh, I have two claims, not one.
[AGENT][POSITIVE] Yes, I can.
[AGENT][NEUTRAL] Are they for the same member or for different members?
[CUSTOMER][NEUTRAL] Different number.
[AGENT][POSITIVE] Yes, I can help you with those, and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thanks. Mhm.
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][POSITIVE] Correct, correct.
[AGENT][NEUTRAL] Thank you and [PII], what it, OK, first off, there's a few things that I need to mention to you. You will use my name that I gave you along with today's date as your call reference number for each claim. Uh-huh. Also any information provided on the claims will be a verification of benefits and not a guarantee of payment. And lastly, if you need a copy of our the explanation of benefits, you may obtain that by going to our portal at secured.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] As a call reference. Sure.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so what is the first member's policy number?
[CUSTOMER][NEUTRAL] Uh, policy number is
[CUSTOMER][NEUTRAL] 01887526
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient first name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] Date of art
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Date of service and total bill amount please.
[CUSTOMER][NEUTRAL] Uh, date of service is for this patient.
[CUSTOMER][NEUTRAL] [PII] and the total bill amount is $4,698 even.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this claim has been received multiple times um and denied for the same reason. The most recently received was on 6-18-2024.
[AGENT][NEGATIVE] Processed and denied the same day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is, yes, sir. The claim number is 347.
[CUSTOMER][NEUTRAL] 618.
[CUSTOMER][POSITIVE] Yes please, yes please.
[AGENT][NEUTRAL] Excuse me, 0066. Again, that's 347.
[CUSTOMER][NEUTRAL] 006.
[AGENT][NEUTRAL] 0066.
[AGENT][NEUTRAL] And the reason for the denial is that we need the primary cop, excuse me, we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Uh, as you can see, this claim number already, uh, uh, and I mean we have this claim number, uh, but, uh.
[AGENT][NEUTRAL] Mhm. And we have not received the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] Actually, uh, this claim number belongs to the, uh, doc under the doctor, uh, which is one moment, please.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] And that is the billed amount.
[CUSTOMER][NEUTRAL] Uh doctor name is [PII]
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And our claim is S.
[CUSTOMER][NEUTRAL] Uh, Luhar MD.
[AGENT][NEUTRAL] For the same exact bill amount?
[CUSTOMER][NEUTRAL] Yes, uh, under the same date of service, same bill amount.
[AGENT][NEUTRAL] I have 2 claims for the same bill amount for that data service.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] That were denied for the same reason. We have not received the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And what is the claim number? 2nd claim number?
[AGENT][NEUTRAL] OK, give me just a moment to look at some additional information on here. What is the tax ID number?
[CUSTOMER][NEUTRAL] Uh-huh, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that claim number is 3470061.
[CUSTOMER][NEUTRAL] 61. OK. And the night for the moment, please. And
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Thanks for the information. Now, can I move on to the next claim?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Uh, give me just a moment, [PII]. I have to make a note on each claim that I checked.
[CUSTOMER][POSITIVE] Sure. No problem. Take your time.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I need one more details. Actually, uh, where I need to send the primary OB because I have the primary OB. So can you please help us uh any uh fax number or any mailing address?
[AGENT][NEUTRAL] The fax number it can be sent to is [PII] excuse me, [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. And is there any pet?
[AGENT][NEUTRAL] Um, make sure to reference the claim number that I gave you and attention claims.
[CUSTOMER][NEUTRAL] Uh, sure. And is there any, uh, timely filing, I mean, timely limit for the primary OB?
[AGENT][NEUTRAL] No, no, sir.
[CUSTOMER][NEUTRAL] OK. One moment, please.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, you're welcome and I'm almost done.
[CUSTOMER][NEUTRAL] And now I'm moving on the.
[AGENT][NEUTRAL] Yeah, just one moment.
[CUSTOMER][NEUTRAL] Next claim.
[AGENT][NEUTRAL] OK, and the next member's policy number, please?
[CUSTOMER][NEUTRAL] Uh, sure, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hold on a moment please.
[CUSTOMER][NEUTRAL] And the next member policy ID number is uh where is listed? 021.
[CUSTOMER][NEUTRAL] 233
[CUSTOMER][NEUTRAL] 18.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][POSITIVE] Mhm. Take your time, no problem.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Patient name is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] [PII]ou're welcome.
[AGENT][NEUTRAL] And the day of service and total bill amount?
[CUSTOMER][NEUTRAL] Uh, date of service is
[CUSTOMER][NEUTRAL] For this patient, what is the date of [PII], and the total bill amount is $3,915 even.
[CUSTOMER][NEUTRAL] And as you can see, uh, we have the claim number also in this.
[CUSTOMER][NEUTRAL] Uh, claim. Uh, it's 35066.
[CUSTOMER][NEUTRAL] Sorry, sorry. 3506.
[CUSTOMER][NEUTRAL] 007.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh I can see uh the claim denial reason is showing claim service denied, at least, at least one remark code must be provided, but I don't have any other information.
[CUSTOMER][NEUTRAL] Under this claim.
[AGENT][NEUTRAL] It states outpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] Um, I don't understand. Sorry, can you repeat one more time?
[AGENT][NEUTRAL] Outpatient benefits for this calendar year has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] 4.
[CUSTOMER][NEUTRAL] Um, there's a.
[CUSTOMER][NEUTRAL] I just calendar here.
[CUSTOMER][NEUTRAL] Has been.
[CUSTOMER][NEUTRAL] Ma
[CUSTOMER][NEUTRAL] And this same claim ID number which is 35060007.
[AGENT][POSITIVE] That is correct, yes, sir.
[CUSTOMER][NEUTRAL] And uh what is the receipt date?
[AGENT][NEUTRAL] [PII], processed on [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Thank you. And so, in this case, uh, in this case, uh, which is the patient responsibility you got from the primary career, uh, which is $72 even. That amount is the patient responsibility?
[AGENT][POSITIVE] You are very welcome [PII].
[AGENT][NEUTRAL] We
[AGENT][NEUTRAL] Yes, sir, we do not determine.
[AGENT][NEUTRAL] We do not determine patient responsibility. That would be up to the provider.
[AGENT][NEUTRAL] To determine that.
[CUSTOMER][NEUTRAL] OK, as for your confirmation, maximum benefit for this calendar year has been met, so there is no any benefit in this plan. OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] That is
[AGENT][NEUTRAL] OK. Well, is there anything else, [PII] I can help you with today?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] Thank you so much. Thanks for the information.
[AGENT][POSITIVE] You will, absolutely. You're very welcome and thank you again for calling APL and I hope you have a great uh and safe New Year.
[CUSTOMER][NEUTRAL] Same to you. Bye for now.
[AGENT][POSITIVE] Thank you. Bye bye.