AccountId: 011433970860
ContactId: 908f371b-917a-482d-adfd-90c026dd3691
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 495769 ms
Total Talk Time (AGENT): 193742 ms
Total Talk Time (CUSTOMER): 175398 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/908f371b-917a-482d-adfd-90c026dd3691_20250205T17:58_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] Hi, this is [PII] calling from providers service to check on a claim status.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you. What is the callback number?
[CUSTOMER][NEUTRAL] My callback number is [PII] and my extension is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Yeah the member ID is 025.
[CUSTOMER][NEUTRAL] 102
[CUSTOMER][NEUTRAL] 999
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The member's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] All right, thank you, and you were needing claim status correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, I can help you with that. And [PII], what is the call I'm sorry, [PII], what is the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII]. The total bill amount is $1,725 even.
[AGENT][NEUTRAL] And what is the facility name?
[CUSTOMER][NEUTRAL] The facility name is Ohio Health Physician Group.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm checking. Do you happen to have a CPT codes?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The ZIP code is [PII] and [PII] and [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] OK, thank you. I appreciate that.
[AGENT][POSITIVE] I was able to locate that claim. Bear with me just one moment and I'll give you the received date and process date and payment information. Let me get that claim pulled up real quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], we received that claim on [PII].
[CUSTOMER][NEUTRAL] Sorry, [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim was processed and paid on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there was a maximum benefit paid of $500.
[AGENT][NEUTRAL] To Ohio Health physician group.
[CUSTOMER][NEUTRAL] OK, paid $500.
[CUSTOMER][NEUTRAL] Is there any denial in this claim?
[AGENT][NEUTRAL] Well, that is the maximum benefit payable for that data service.
[CUSTOMER][POSITIVE] Maximum benefits pay.
[AGENT][NEUTRAL] That was, yeah, yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. I could see here uh the, for the CPT code [PII] and [PII] for that no payment was made. May I know the reason for that?
[AGENT][NEUTRAL] That is
[AGENT][NEUTRAL] The maximum benefit payable for that data service was met.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then there um.
[AGENT][NEUTRAL] There are no, the policy provides no benefits for charges made by a doctor for inpatient visits.
[CUSTOMER][NEUTRAL] Sorry, could you please say that again?
[AGENT][NEUTRAL] The policy provides no benefits payable for charges made by a doctor for inpatient benefits.
[CUSTOMER][NEGATIVE] Policy provides no benefit payable. And then,
[CUSTOMER][NEUTRAL] What you said?
[AGENT][NEGATIVE] No benefits for charges made by a doctor for inpatient visits.
[CUSTOMER][NEUTRAL] For the inpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For this one, what action can we take? Can we send us a correct claim or uh can we send us a, can we send us an appeal?
[AGENT][NEUTRAL] You have a right to an appeal, but the benefits were paid and maxed out.
[AGENT][NEUTRAL] For the covered charges. Uh, the appeal time frame is 180 days from denial.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Exactly
[CUSTOMER][NEUTRAL] OK. May I know how much is the maximum uh benefits for the date of service, Maximum allowed benefit for the date of service.
[AGENT][NEUTRAL] For that service is $500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What are you doing?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry, I'm asking, you said uh
[CUSTOMER][NEUTRAL] For this claim, uh, has
[CUSTOMER][NEUTRAL] For this claim has reached the maximum benefit, right? I'm asking, um,
[AGENT][POSITIVE] Mhm. That is correct.
[CUSTOMER][NEUTRAL] Whether it is, yeah, whether it is uh.
[CUSTOMER][NEUTRAL] Whether it is an uh allowed units or uh visit.
[AGENT][NEUTRAL] It's dollar amount.
[CUSTOMER][NEUTRAL] Dollar amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. Can I have the
[CUSTOMER][NEUTRAL] A your mailing address.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. Got it.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Can I have the payer ID?
[AGENT][NEUTRAL] Payer ID is 60801.
[CUSTOMER][NEUTRAL] OK. Is there any fax number is available for bill?
[AGENT][NEUTRAL] 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 942 3.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it. Could you please provide me the claim number?
[AGENT][NEUTRAL] Claim number is 355.
[AGENT][NEUTRAL] 2176.
[CUSTOMER][NEUTRAL] 21
[AGENT][NEUTRAL] Yes, sir. 2176. Mhm.
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] OK. Got it.
[CUSTOMER][NEUTRAL] Can you send us an appeal through portal?
[AGENT][NEUTRAL] You can if you have an active online service center account through the APL portal.
[CUSTOMER][NEUTRAL] Sorry, which portal?
[AGENT][NEUTRAL] Secured. [PII] portal.
[CUSTOMER][NEUTRAL] In public.
[AGENT][NEUTRAL] If you have that promoted provider portal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] That's it for this claim. Um.
[CUSTOMER][NEUTRAL] Can you please spell your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] And it was a pleasure to assist you with that claim status, [PII]. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, can I have the call reference number?
[AGENT][NEUTRAL] Call reference number is my name and today's date.
[CUSTOMER][NEUTRAL] OK. Got it.
[CUSTOMER][POSITIVE] Thank you so much for providing all the information. Have a wonderful day.
[AGENT][NEUTRAL] What
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful day as well, [PII], and thank you. Take care.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Thank you. Bye.