AccountId: 011433970860
ContactId: 7d3a5b8e-f608-43c1-9ba5-57cebd88a5ce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 311859 ms
Total Talk Time (AGENT): 107810 ms
Total Talk Time (CUSTOMER): 67130 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/7d3a5b8e-f608-43c1-9ba5-57cebd88a5ce_20250214T13:57_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hey there, this is [PII] calling from Motion Orthopedics. I'm just calling to check on a bill we submitted for a patient.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim, and I'm sorry, can you repeat your name for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, so it's [PII] and then the policy number is gonna be 02141803.
[AGENT][NEUTRAL] 02141823.
[CUSTOMER][NEUTRAL] 03.
[AGENT][NEUTRAL] 03. OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], last name [PII] Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Data service is [PII].
[AGENT][NEUTRAL] And the total bill?
[CUSTOMER][NEUTRAL] $749.68.
[AGENT][NEUTRAL] 2968.
[AGENT][NEUTRAL] Alright, and is it OK if I place you on just a brief hold while I locate the claim for you?
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Hey.
[AGENT][POSITIVE] Hey, thank you so much for holding. I apologize for that wait, and I did locate the um claim. Can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Motion orthopedics.
[AGENT][NEUTRAL] OK, so I'm showing that we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 35568003.
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] As office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] OK. And is that for all the codes or just the office visit code?
[AGENT][NEUTRAL] Um, that's just for the office visit code. Let me see the others. Hold on one moment.
[AGENT][NEUTRAL] For code 20552.
[AGENT][NEUTRAL] It was denied because the um primary insurance provided full benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For code 72,070.
[AGENT][NEUTRAL] Um, uh, let me see. Benefits were applied to the $1000 calendar year deductible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's for 72,070 and 1010.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] And then uh you said that was on 128. I, I assume that maybe an EOB was mailed, but is there a way you can send me a copy of it via fax as well?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Yeah, so that is [PII].
[AGENT][NEUTRAL] And should I put attention, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Alright, so I'll go ahead and send the explanation of benefits over to you now. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Nope, that was it. Thank you so much.
[AGENT][POSITIVE] You're very welcome. Well, thank you for calling APL and I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You too.