AccountId: 011433970860
ContactId: 7a997210-9811-4b2a-8a98-12e20cb6fda5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 468899 ms
Total Talk Time (AGENT): 203572 ms
Total Talk Time (CUSTOMER): 126991 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/7a997210-9811-4b2a-8a98-12e20cb6fda5_20250218T13:17_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good morning. Thank you for calling
[CUSTOMER][NEUTRAL] Yeah, it's so yeah from provider's office looking status.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Yes, ma'am. What is your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], is that correct? [PII]?
[CUSTOMER][NEUTRAL] [PII]. No, it's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes. Yes, ma'am.
[AGENT][NEUTRAL] OK, [PII], and you're needing claim status, is that also correct?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes ma'am, I can help you with that. And so yeah, how many claims do you have to check today?
[CUSTOMER][NEUTRAL] Uh, one moment, please.
[CUSTOMER][NEUTRAL] Only one.
[AGENT][NEUTRAL] OK, and what is your patient's policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So it's 02433267.
[CUSTOMER][NEUTRAL] I.
[AGENT][POSITIVE] Thank you one moment please.
[CUSTOMER][NEUTRAL] Yeah, sure, ma'am.
[AGENT][NEUTRAL] And so yeah, any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] It's uh [PII]. And date of birth, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] OK. So date of service [PII] and charge amount 433 88 cents.
[AGENT][NEUTRAL] OK, so 5 2024 for 438. Is that correct? 438.
[CUSTOMER][NEUTRAL] 5.
[CUSTOMER][NEUTRAL] 528 2024 and 433.88.
[AGENT][NEUTRAL] OK. All right, give me just one moment. So 528-2024, and again, what was the bill amount?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah, sure, ma'am.
[CUSTOMER][NEUTRAL] 433.88.
[AGENT][NEUTRAL] 433.88, is that correct?
[CUSTOMER][NEUTRAL] Uh-huh. Yes.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] OK. So this claim was received on 11-7-2024.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Processed on
[CUSTOMER][NEUTRAL] One moment please.
[CUSTOMER][NEUTRAL] 11:28.
[CUSTOMER][NEUTRAL] all
[AGENT][NEUTRAL] No, ma'am. 11-7-2024. Processed 11-11-2024. What is the name of the uh facility or group for this claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's not at the North Atlanta Primary Care.
[AGENT][NEUTRAL] Could it also be called something else?
[CUSTOMER][NEUTRAL] Southeast Medical Group.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So I do show that this claim was, the claim number is 352.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 8334. There was a benefit paid in the amount of $23.81.
[AGENT][NEUTRAL] That was paid on single check 201.
[AGENT][NEUTRAL] 2944.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And that check did clear on [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] The other codes were denied. One of them was denied as office visits are not covered by this policy.
[AGENT][NEUTRAL] And the other codes were denied as benefits are paid only if the major medical insurance provider provides benefits.
[AGENT][NEUTRAL] If this claim is later paid by your major, excuse me, your major medical insurance, please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] OK. So 99214, it's denied, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] For uh
[AGENT][NEUTRAL] As I stated, office visits are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Under the members, under the payment plan.
[CUSTOMER][NEUTRAL] In uh insurance?
[CUSTOMER][NEUTRAL] Office visit is not covered under patient plan or insurance.
[AGENT][NEUTRAL] Patience plan
[CUSTOMER][NEUTRAL] OK. And uh what do we have to do for this?
[AGENT][NEGATIVE] I don't understand your question.
[CUSTOMER][NEUTRAL] What do we have to do for this?
[AGENT][NEUTRAL] What do you mean? What do you have to do for this?
[CUSTOMER][NEUTRAL] For CPT 99214.
[AGENT][NEUTRAL] APL does not determine patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] OK, so you mean it's patient responsibility.
[AGENT][NEUTRAL] No, ma'am, that's not what I said. I said that APL does not determine patient responsibility. That would be up to the provider to determine patient responsibility.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits so you, you may print that by going to our portal and the website for our portal is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and please spell your name for me.
[AGENT][NEUTRAL] [PII] and then my name and today's date would be your call reference number.
[CUSTOMER][NEUTRAL] OK, and last name.
[AGENT][NEUTRAL] Yes and yours?
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] What is your last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, ma'am. Thank you so much.
[AGENT][POSITIVE] OK, well, thank you very much [PII] for calling APO and I hope that you have a nice day.
[CUSTOMER][POSITIVE] Thank you so much have a great day bye bye.
[AGENT][POSITIVE] You, yes, ma'am. You're welcome. Bye-bye.