AccountId: 011433970860
ContactId: 92d5cb44-61c6-4db7-8881-bbdbc51ee2fd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 385980 ms
Total Talk Time (AGENT): 151108 ms
Total Talk Time (CUSTOMER): 84778 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/92d5cb44-61c6-4db7-8881-bbdbc51ee2fd_20250113T22:43_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][POSITIVE] Hi, my name is [PII] calling from provider's office. I'm looking on a claim status. So we're doing very well today.
[AGENT][POSITIVE] OK, yeah, I can definitely help you with the claim status today. [PII], do you mind if I get a good call back number for you?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Wonderful. Thank you so much. And what is your member's policy number today?
[CUSTOMER][NEUTRAL] 023
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 993.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 12.
[AGENT][POSITIVE] Wonderful. One more second. And can you verify their first and last name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Yup. [PII], [PII].
[AGENT][POSITIVE] Perfect. Thank you so much. And give me one second to get those claims ready and
[AGENT][NEUTRAL] Did you have a claim number in particular you want to look at or did you want me to search it for you?
[CUSTOMER][NEUTRAL] Um, just a moment. Let me, actually, we don't see any claim number.
[AGENT][NEUTRAL] OK, yeah, let me take a look what's the date of service?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] With the total charge amount $19.62.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] And what is the name of the.
[AGENT][NEUTRAL] Um, the facility office on file?
[CUSTOMER][NEUTRAL] Dermatology Associates.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] And I was able to find that claim for you. It looks like we received your claim on [PII]. Um, it looks like that claim was processed [PII]. I do have your
[AGENT][NEUTRAL] Claim number is 352-7451.
[AGENT][NEUTRAL] And it does look like that claim did have a benefit payable of $25 and it looks like it was paid by via check. Um, I have the check number is 2,012,520.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] No, no. I uh I see the check we have received, but uh I can see only one CPT code has paid 99213. Whereas other two CPT codes, I see there is a zero bill paid amount.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, so they both have denial codes on them and they say the same thing. It says the maximum benefit amount for the treatment period providing during this, I'm so sorry, let me start that over. The maximum benefit amount for treatment provided during this office visit has been exhausted. No benefits are payable for the service.
[CUSTOMER][NEUTRAL] S
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] Just no.
[CUSTOMER][NEUTRAL] Do you have any date regarding the check-in date?
[AGENT][POSITIVE] I'm, I'm so sorry. Do I have any what?
[CUSTOMER][NEUTRAL] Uh, actually looking for check and cash date when it was in cash.
[AGENT][NEUTRAL] Oh, OK, yeah, let me pull that back up for you [PII].
[AGENT][NEUTRAL] I show that the check was issued on [PII] and it was cleared on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is.
[CUSTOMER][NEUTRAL] So the other remaining CBD code won't pay any amount as it is has been in dispute.
[AGENT][NEUTRAL] Um, yes, that's correct. So the, the remaining ones.
[AGENT][NEGATIVE] are denied because uh the benefits have been used for that visit.
[CUSTOMER][NEUTRAL] It was used previously or else like it won't be as per any guidelines?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I guess I'm not quite understanding your question. So for their visit, they only had $25 available and so you received the max payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please spell your name for documentation?
[AGENT][NEUTRAL] Yes, absolutely. The name is [PII] last name, [PII], and then um if you need a reference number, it's just my name in today's date as well.
[CUSTOMER][POSITIVE] Uh, have a great day. Bye-bye.
[AGENT][POSITIVE] Thanks bye bye.