AccountId: 011433970860
ContactId: 7d543785-c2ca-4192-a322-84ee1506007b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 506480 ms
Total Talk Time (AGENT): 201266 ms
Total Talk Time (CUSTOMER): 157135 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/7d543785-c2ca-4192-a322-84ee1506007b_20250521T12:53_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good Morning, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Pro office checking on the claims.
[AGENT][NEUTRAL] OK, did you say your name is [PII]? Is that correct?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] And you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] OK denial base and correct.
[AGENT][NEUTRAL] OK, so you're needing the reason for a denial on a claim. Is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yeah, yeah, yes, yes, ma'am.
[AGENT][POSITIVE] Yes, I can help you with that and what is your callback number, please?
[CUSTOMER][NEUTRAL] Sure, ma'am. Callback number will be [PII] with the extension of [PII].
[AGENT][NEUTRAL] Thank you. And [PII], how many claims do you have to check today?
[CUSTOMER][NEUTRAL] Only one
[AGENT][NEUTRAL] OK. And what is that member's policy number, please?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, that will be.
[CUSTOMER][NEUTRAL] 025204
[CUSTOMER][NEUTRAL] 27
[AGENT][NEUTRAL] OK, thank you, [PII]. One moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] OK, ma'am.
[AGENT][NEUTRAL] I mean the information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure. Patient first name will be [PII]. Last name will be [PII]
[CUSTOMER][NEUTRAL] Date of birth will be [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is the date of service and total bill amount that you're calling in regards to?
[CUSTOMER][NEUTRAL] Sure, ma'am. Date of service will be [PII]. And then the bill amount will be $570 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, let's go
[AGENT][NEUTRAL] OK, so this claim has been received more than once. The most recent received claim was denied as a duplicate. Are you needing the original claim information, [PII]?
[CUSTOMER][NEUTRAL] Ma'am, actually, this claim has been partially paid and denied. And then the CPT 99214 is denied for non-covered charges.
[AGENT][NEGATIVE] No, sir, that's incorrect information.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] So do you already have the claim number?
[CUSTOMER][NEUTRAL] OK, ma'am. Uh just provide me the
[CUSTOMER][NEUTRAL] Uh, yeah, I have the claim number that is uh 354-7090.
[AGENT][NEUTRAL] OK, so that is the claim that is denied as a duplicate of previously submitted expenses. The entire claim was denied.
[CUSTOMER][NEUTRAL] Just tomorrow.
[CUSTOMER][NEUTRAL] Just a moment, ma'am, uh, yeah.
[AGENT][NEUTRAL] Uh-huh. You're welcome. Mhm.
[AGENT][NEUTRAL] OK. And then the original claim that was received is claim number 3537061.
[CUSTOMER][NEUTRAL] So just go out.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on that claim there was a $75 benefit paid.
[CUSTOMER][NEUTRAL] Uh, just a little.
[AGENT][NEUTRAL] On
[AGENT][NEUTRAL] The 99214 code.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you need the check number on that?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. The check number.
[AGENT][NEUTRAL] It's going to be 201.
[AGENT][NEUTRAL] 6666.
[CUSTOMER][NEUTRAL] Yeah. What is a single amount or bulk amount?
[AGENT][NEUTRAL] Single amount and it cleared on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 2.
[CUSTOMER][NEUTRAL] We go.
[AGENT][NEUTRAL] And the other codes were the issue date was the same date as the process date [PII].
[CUSTOMER][NEUTRAL] You sure did, ma'am.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And the other codes were denied on the claim.
[CUSTOMER][NEUTRAL] Go ahead, ma'am.
[AGENT][NEUTRAL] And the reason for denial on states the maximum benefit payable for this state of service has been met.
[AGENT][NEUTRAL] And the other one is via puncture is not covered by the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] If you don't want, you can access the original uh original EOB ma'am, original pay EOB.
[AGENT][NEUTRAL] Are you
[AGENT][NEUTRAL] Just a moment. Are you also able to access the internet, [PII], where you can, for the future, be able to print them yourself directly from our portal?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Our website for our portal where you can print them yourself, is located at [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] [PII], right, ma'am?
[AGENT][NEUTRAL] Yes, sir. Uh-huh, secured. [PII].
[AGENT][NEUTRAL] Just one moment while I'm loading, getting the EOB pulled up to fax it to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can provide the fax number.
[AGENT][NEUTRAL] In just a moment. I'm not ready for that yet. I'll get that in just a second.
[CUSTOMER][POSITIVE] OK, no problem. Take your time. Take your time, ma'am.
[AGENT][NEUTRAL] Go ahead and give you can give me the fax number now, [PII].
[CUSTOMER][NEUTRAL] Yeah, ma'am. Uh.
[CUSTOMER][NEUTRAL] Fax number is [PII].
[AGENT][NEUTRAL] And does this need to be put to your attention or is that not necessary?
[CUSTOMER][NEUTRAL] Uh, no, ma'am. Uh, actually, my name and today's date.
[CUSTOMER][NEUTRAL] Uh, it shows [PII], right?
[CUSTOMER][NEUTRAL] Well I
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] OK, and again, you said your fax number is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][POSITIVE] Exactly, exactly.
[AGENT][POSITIVE] OK, so I have just sent that to you, [PII], so you should be receiving that very soon.
[CUSTOMER][NEUTRAL] OK, ma'am. Just spell your name.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh man.
[AGENT][NEUTRAL] And you will use my name along with today's date for your call reference number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, ma'am. I just end up the call with this. So once again, thank you for and a wonderful day. Bye for now.
[AGENT][NEUTRAL] OK, and.
[AGENT][POSITIVE] OK, well then you're very welcome, [PII], and thank you for calling APL and I hope you have a nice day also.
[CUSTOMER][POSITIVE] OK. Take care, bye.
[AGENT][NEUTRAL] You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.