AccountId: 011433970860
ContactId: 7cf63692-84d6-49e0-98ff-31c58142253a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 426929 ms
Total Talk Time (AGENT): 96671 ms
Total Talk Time (CUSTOMER): 102887 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/7cf63692-84d6-49e0-98ff-31c58142253a_20250521T14:38_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I?
[CUSTOMER][NEUTRAL] Yeah, hi. This is [PII] calling from the provider office regarding a claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Um, may I please get your callback number, sir, just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. My callback number is [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you sir and then what is the name of the facility you'll be calling you're calling from?
[CUSTOMER][NEUTRAL] Yeah, actually, I'm calling from Bone and Joint Clinic of Baton Rouge.
[AGENT][NEUTRAL] OK, and then may I get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. Patient's name is [PII].
[CUSTOMER][NEUTRAL] And data, but for the patient that is [PII]. And the policy number is 02460661.
[AGENT][NEUTRAL] OK, let me look him up real quick.
[AGENT][NEUTRAL] OK, and may I have the date of service and the charge amount?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, sure. That service the charge amount that is.
[CUSTOMER][NEUTRAL] [PII] and the total bill amount that is $446 even.
[AGENT][NEUTRAL] OK, and then what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] The remaining charges are $55 and even.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold, [PII], while I look up this claim and I'll be right back, sir.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I have the claim information for you.
[AGENT][NEUTRAL] The claim number is 3599066.
[AGENT][NEUTRAL] And the claim has been denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Under patient policy. OK, may I know when the claim is made on?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Uh, we received the claim on [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] Oh, that's the second business.
[CUSTOMER][NEUTRAL] OK, this claim has been got in it for office visit is not covered under the.
[CUSTOMER][NEUTRAL] Patient's policy, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] You mean what is the patient policy?
[AGENT][NEUTRAL] Patient policy is Medlink.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Can you please spell out the name for me?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's Metlink.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] Just a second, please.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Just give me a quick second, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the provider or out of network?
[AGENT][NEUTRAL] I'm sorry, can you repeat the question?
[CUSTOMER][NEUTRAL] May I know the provider is in-network or out of network?
[AGENT][NEGATIVE] They don't have a network.
[CUSTOMER][NEGATIVE] They don't have a network.
[CUSTOMER][NEUTRAL] OK. As per patient policy, may I know which the CPT code is not covered or the DX code is not covered?
[AGENT][NEUTRAL] Under the patient's policy, their office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a second, please.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] May I know what is the uh time you contact them?
[CUSTOMER][NEUTRAL] Time limit.
[AGENT][NEGATIVE] Uh, we do not have a timely filing limit.
[CUSTOMER][NEUTRAL] Do you have a claim mailing address so we can submit the claim?
[AGENT][NEGATIVE] Uh, you've already submitted the claim and it was denied.
[CUSTOMER][POSITIVE] OK. Thank you for the information and
[CUSTOMER][NEUTRAL] Can you please spell out your name for me?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] Thank you, [PII]. Can I get a call reference number for our call, please?
[AGENT][NEUTRAL] Yes, you can use my name and today's date.
[CUSTOMER][POSITIVE] Uh, thank you for the information. Have a great day. Bye.
[AGENT][POSITIVE] You too you have a wonderful day, [PII]. Thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye-bye, sir.