AccountId: 011433970860
ContactId: 7f89b1f3-7405-474a-9700-e46768c07245
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 265880 ms
Total Talk Time (AGENT): 70148 ms
Total Talk Time (CUSTOMER): 82779 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/7f89b1f3-7405-474a-9700-e46768c07245_20250313T15:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from providers office regarding to ship the claim status. Could you please help me with that?
[AGENT][POSITIVE] All right, [PII], I'm happy to check on a claim for you today. Do we have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, I do have. It is 02331433.
[AGENT][POSITIVE] All right, thank you for that. And do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah it is [PII]. It is a direct line.
[AGENT][NEUTRAL] Thank you. And may I please have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. Patient last name is [PII] and first name is [PII] and date of birth of the member is [PII].
[AGENT][POSITIVE] Thank you. Data service?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Give me one second. And date of service is [PII] with the bill amount of $108.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, so it looks like we did receive a claim for this state of service. Claim is received [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim was denied, office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me 1 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] OK. Can we bill it to patient?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility. That's up to the facility or provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you have any chance to send a um collected claim?
[AGENT][NEUTRAL] You can resubmit the claim, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So, this CPT code is not covered under the patient plan, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So can we make any changes in that code?
[AGENT][NEUTRAL] You can resubmit the claim if it needs to be corrected.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Can I get the claim number?
[AGENT][NEUTRAL] 352-213-2.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, and what is that denied date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, perfect. And is there have any time finding limit for this one?
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] OK, perfect. And what is the call reference number?
[AGENT][NEUTRAL] Call reference is going to be my name with my last initial and then today's date. My name again is [PII], that's [PII] Last initial is [PII].
[CUSTOMER][POSITIVE] OK perfect thank you so much for providing this information. Have a good day bye for now.
[AGENT][NEUTRAL] You too bye bye.
[CUSTOMER][NEUTRAL] Yeah bye bye.