AccountId: 011433970860
ContactId: 7bdad7e0-529d-4430-9196-c18972a4b8ee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1063819 ms
Total Talk Time (AGENT): 258754 ms
Total Talk Time (CUSTOMER): 203028 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/7bdad7e0-529d-4430-9196-c18972a4b8ee_20250115T18:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling STL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from the provider's office to check on claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status and did you say your name is [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, what is your callback number, sir?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name?
[CUSTOMER][NEUTRAL] And the patient's name is, just a minute.
[CUSTOMER][NEUTRAL] And the patient's name is uh
[CUSTOMER][NEUTRAL] Madai [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And then what's the patient's policy number?
[CUSTOMER][NEUTRAL] It's 02512377.
[AGENT][NEUTRAL] OK, let me pull in the policy for us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, and then what is the date of service?
[CUSTOMER][NEUTRAL] And the date of service is [PII].
[AGENT][NEUTRAL] OK, and what was the month again, please?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and what's the charge amount?
[CUSTOMER][NEUTRAL] $337 even.
[AGENT][NEUTRAL] OK, let me pull up that claim for you. I'm gonna, uh, what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Community Medical Associate.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I pull in that claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding for me, [PII]. So the claim was paid, um, the claim number is 3514789.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim was paid with check number.
[CUSTOMER][NEUTRAL] Sorry, 789 8.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] And the check number is 2.
[CUSTOMER][NEUTRAL] It's 351-478-9, right?
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] Check number is 20066448.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] And the amount of $50.
[AGENT][POSITIVE] And the check has cleared.
[AGENT][NEUTRAL] The bank
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] After that $50 was paid, then it maxed out the benefits payable for that day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's a single check or bulk.
[AGENT][NEUTRAL] It's single.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But the claim is, uh, total bill amount is $337 right?
[AGENT][NEGATIVE] Yes, that's what you sent in, but once the $50 was paid, it, it, uh, exhausted the benefits for the day.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] But we we have received the UOB.
[CUSTOMER][NEUTRAL] In that, uh, we don't know whether.
[AGENT][NEUTRAL] I can send you an EOB.
[CUSTOMER][NEUTRAL] No, we already have an EOB and the number 3534031.
[CUSTOMER][NEUTRAL] And that we cannot see any patient's responsibility or whether it's members responsibility.
[AGENT][NEUTRAL] You said you received an EOB that is 354-031?
[CUSTOMER][NEUTRAL] Yeah, 353403-1.
[AGENT][NEUTRAL] OK, let me look up that EOB.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You received that EOB because it was a duplicate of the original EOB which was 3514789. That EOB 3534031 is because the claim was sent in more than one time.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Prime is send more than one time, right?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] But the claim is paid $50.
[AGENT][NEUTRAL] For that date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] May I know whether this is patient responsibility of providers?
[AGENT][NEUTRAL] I can't give patient responsibility, that's determined by the provider.
[CUSTOMER][NEUTRAL] It is determined by the provider, right?
[AGENT][NEUTRAL] It yeah it's determined by the provider.
[CUSTOMER][NEUTRAL] May I please place the call on hold for a moment?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome, sir.
[CUSTOMER][POSITIVE] Hello. Thank you for waiting online.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We are the same patient, uh sound to claims. We have done the same thing for all the claims.
[AGENT][NEUTRAL] You had, I'm sorry, you said the patient had 3 claims and you received the same reason for 3 claims?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] Yeah, we have 77 claims for this patient.
[CUSTOMER][NEGATIVE] Under the same issue.
[AGENT][NEUTRAL] OK, the benefits have been exhausted.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah I sent the UP but uh we couldn't see any whether it's patient responsibility or whether it's members responsibility.
[AGENT][NEUTRAL] That's because we don't give that, we don't, we don't ever send if it's patients responsibility. We do not give that information.
[CUSTOMER][NEUTRAL] OK. We have checked in your portal.
[AGENT][NEUTRAL] That is always determined by the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So we should follow, we should determine whether what should be doing right.
[AGENT][NEUTRAL] Uh, I can't give you advice on how your facility should collect payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a minute.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEUTRAL] May I know whether the CPT 99203?
[CUSTOMER][NEUTRAL] It's uh only allowed amount is 50 per day.
[CUSTOMER][NEUTRAL] $50 per day, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look and see um what it says. I can only give the information that's on the claim and the remarks on the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the remarks on the claim that after that $50 was paid.
[AGENT][NEGATIVE] It exhausted the benefits for that date of service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] Just a minute.
[CUSTOMER][NEUTRAL] And that.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Deliver.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah, since, uh,
[CUSTOMER][NEUTRAL] Members has a limited uh benefit plan policy.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So what are remaining is patient responsible, right?
[CUSTOMER][NEGATIVE] Not the provider right off.
[AGENT][NEUTRAL] What did you say?
[AGENT][NEUTRAL] I can't give you responsibility of how the pay, the rest of the payment should be paid.
[CUSTOMER][NEUTRAL] Where we can get the info those informations.
[AGENT][NEUTRAL] From the provider that you work for.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So in this case, we can't build the member.
[AGENT][NEUTRAL] That is not for me to determine. That's determined by the provider.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So the claim is paid without any denial, right?
[AGENT][NEUTRAL] The claim was paid.
[AGENT][NEGATIVE] After it was paid $50 it exhausted the benefits for that day.
[AGENT][NEUTRAL] The result is always going to be the same no matter how you ask the question, the payment was paid $50 with check number 2006648 after the $50 was paid, it exhausted the benefits for the day.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] That is all the information I can give you.
[CUSTOMER][NEUTRAL] So you'll process the claim under the provider's contract, right?
[AGENT][NEUTRAL] Under the patient's policy.
[CUSTOMER][NEUTRAL] We'll process on patient policy.
[CUSTOMER][NEUTRAL] This policy, OK.
[AGENT][NEUTRAL] We processed under the patient's policy.
[AGENT][NEUTRAL] The way the policy is written.
[AGENT][NEUTRAL] After paying the $50.
[AGENT][NEGATIVE] It exhausted the benefits for the day. I cannot give you patient responsibility. I cannot tell you how to collect the rest of the money.
[AGENT][NEUTRAL] That is determined by the provider.
[CUSTOMER][NEUTRAL] You pay the claim as for this contract, right?
[AGENT][NEUTRAL] We paid the claim as the patient's policy contract reads, yes.
[CUSTOMER][NEUTRAL] OK. May I know your name for documentation?
[AGENT][NEUTRAL] Yes, my name is [PII]
[CUSTOMER][NEUTRAL] Mhm. I know the call reference for the call.
[AGENT][NEUTRAL] Yes sir, you can use my name and today's date.
[CUSTOMER][POSITIVE] Thank you too. Have a great day. Bye-bye.
[AGENT][POSITIVE] You too, [PII] you have a blessed one. Thanks for calling APL.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Mhm. Bye-bye.
[AGENT][NEUTRAL] Oh