AccountId: 011433970860
ContactId: 82fdabc7-eb1d-4006-9ec4-c04f97eca984
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 707549 ms
Total Talk Time (AGENT): 220424 ms
Total Talk Time (CUSTOMER): 124558 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/82fdabc7-eb1d-4006-9ec4-c04f97eca984_20250421T20:53_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh yeah, my name is [PII]. I'm looking for claims calling on the provider office.
[AGENT][NEUTRAL] OK, well, I'll be more than happy to help you with the claim status, and um, how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Uh, only one.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and uh member ID is 02090866.
[AGENT][NEUTRAL] OK, so the phone went in and out. Did you say 02090866?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Member's name uh A. Date of birth is [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 and the total bill?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII], bill amount $40.
[AGENT][NEUTRAL] OK, thank you, hold on one moment.
[AGENT][NEUTRAL] And [PII], do you mind if I place you on just a brief hold while I locate the claim?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[AGENT][POSITIVE] Thank you so much for holding. What is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] BMD Primary provider Central Kentucky PSC.
[AGENT][NEUTRAL] Um, OK, what's the tax ID?
[CUSTOMER][NEUTRAL] Tax ID [PII].
[AGENT][NEUTRAL] OK, is there any other total bill that the claim can be because we do have a claim here on file. We only received two claims for this data service. One of them is from your provider, but it's a different total bill.
[CUSTOMER][NEUTRAL] $254.08.
[AGENT][NEUTRAL] $254.08.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm showing one for $245.05.
[AGENT][NEUTRAL] And then the other one was.
[AGENT][NEUTRAL] So both of the claims are from your provider. One is a total of 2 cents, the other is a total of $245.05.
[AGENT][NEUTRAL] Did you want the claim status for the 24505 or is this or is this not the claim?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, what is the claim number?
[AGENT][NEUTRAL] Well, that's what we're trying to figure out. So I'm trying to see if this is the claim that you need or not. Is there another total bill?
[AGENT][NEGATIVE] Because if not, this total bill does not match what you gave, and the other one is a total of 2 cents.
[AGENT][NEUTRAL] What are the procedure codes on your claim that you're calling in reference to?
[CUSTOMER][NEUTRAL] 99203.
[AGENT][NEUTRAL] OK, that's one. Is there a G as in girl, 8510 on the claim as well?
[CUSTOMER][NEUTRAL] No, but I need uh 99203 CPT 9.
[AGENT][NEUTRAL] I understand your question. I'm trying to locate the correct claim for you. If these are not, if the there's several codes on here, is the code you're looking for, does it have just one code or is it several codes because this
[CUSTOMER][NEUTRAL] Several goats.
[AGENT][NEUTRAL] OK, so then this might be it. It's just a different total bill. OK, so this claim total bill is $245.05.
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 345, I'm sorry, 353.
[AGENT][NEUTRAL] 4018.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Uh, hold on one moment.
[CUSTOMER][NEUTRAL] What is the claim number?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] I did it backwards. Hold on one second.
[AGENT][NEUTRAL] The claim number is 3534018.
[AGENT][NEGATIVE] And it was denied because office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Actually, I don't have this thing you be, uh, yeah, I.
[AGENT][NEUTRAL] OK, I can fax it to you. What's a good fax number?
[CUSTOMER][NEUTRAL] Uh you are saying for the the reason for 99203, right? CPT?
[AGENT][NEGATIVE] Right, it was denied because office visits are not covered on the policy.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So services not covered under patient plan, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Can we bill it to the patient?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility because we're not the major medical. Um, if there is an outstanding balance, it would just be whatever your procedures are for remaining our outstanding balances.
[CUSTOMER][NEUTRAL] OK. Can you do fax C will be 31.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, I'm sorry. Hold on.
[AGENT][NEUTRAL] Are you giving me, hold on one moment. Are you giving me a phone number? What are these numbers that you're giving me?
[CUSTOMER][NEUTRAL] Fax number.
[AGENT][NEUTRAL] OK, can you repeat it, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and attention to my name, [PII].
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] One moment, let me check.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] You are the primary payer or secondary. I actually, my, in my system, you are the secondary payer.
[AGENT][NEUTRAL] OK, so I just
[AGENT][NEUTRAL] Yes, and I just um faxed over the explanation of benefits.
[AGENT][POSITIVE] To you, so you should be receiving that in the hour. If you have not received it by end of day today, you definitely can give us a call back and we'll be more than happy to resend it for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Your name and call reference number.
[AGENT][NEUTRAL] My name is [PII] First initial to my last name is [PII]. There is no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome, [PII]. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thanks for calling APO have a great day.
[AGENT][NEUTRAL] Bye bye.