AccountId: 011433970860
ContactId: 94b5bfa9-af05-4c44-9b52-649125b6cf4d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 840299 ms
Total Talk Time (AGENT): 238967 ms
Total Talk Time (CUSTOMER): 210534 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/94b5bfa9-af05-4c44-9b52-649125b6cf4d_20250508T18:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from the provider office to check for claims.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status, sir. Can I please get your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Um, one minute.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] So it is [PII].
[CUSTOMER][NEUTRAL] 4630.
[CUSTOMER][NEUTRAL] And the member name I have here is [PII]. It is M A R Q Queen, E echo, Larry, Larry, Markwell.
[CUSTOMER][NEUTRAL] And Duke's Delta Uniform Kite Echo Sierra.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, let me pull up [PII]'s policy real quick.
[AGENT][NEUTRAL] All right, and then can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it is uh [PII].
[CUSTOMER][NEUTRAL] Total charge is $260 even.
[AGENT][NEUTRAL] OK, and then please give me the name of the facility you're calling for.
[CUSTOMER][NEUTRAL] Yeah, it is Low Country urology clinics.
[AGENT][NEUTRAL] OK, [PII] I'm gonna put you on a brief hold while I look up this claim for us and I will be right back sir.
[CUSTOMER][NEUTRAL] Very.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you [PII] for holding for me. I have the claim information for you. The claim number is 3579345.
[AGENT][NEUTRAL] The claim was paid $75 after the $75 that maxed out the benefit.
[AGENT][NEUTRAL] With check number 203-4331, the check did clear the bank on [PII].
[CUSTOMER][NEUTRAL] So the payment amount is $75 even and uh the check number 204, I'm sorry, 2034231.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] 203-433-1.
[CUSTOMER][NEUTRAL] 4331 is a single check?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK. And uh no member responsibility?
[AGENT][NEUTRAL] We don't give patient responsibility we let the the provider determine that.
[CUSTOMER][NEUTRAL] OK, so, uh, for the two line items G2211 and 81002, I mean it is denied for maximum benefits met for this time period.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And uh is it based on number of visits or dollar amount?
[AGENT][NEUTRAL] It's based on dollar amount the um.
[AGENT][NEGATIVE] And this is just to verify benefits. It's not a guarantee of payment. They get $75 and that's what what it paid was $75.
[CUSTOMER][NEUTRAL] And you, they don't have anything for um I mean, evaluation and uh urinary analysis?
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] Love series.
[AGENT][NEUTRAL] No, it, it's just the, the visit itself pays $75 and it maxed out the benefit for that day.
[CUSTOMER][NEUTRAL] OK, so the benefits is only a met, I mean only met completely for the EM services office visit.
[AGENT][NEUTRAL] Right. They get paid 75, they, their benefit is $75. They get 4 visits per year and it pays $75.
[CUSTOMER][NEUTRAL] OK, one minute.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's just a set amount.
[CUSTOMER][NEUTRAL] $75.
[CUSTOMER][NEUTRAL] 4 visits per year.
[CUSTOMER][NEUTRAL] So for each year only $75.
[AGENT][NEUTRAL] No, for each visit, only $75.
[CUSTOMER][NEUTRAL] With
[AGENT][NEUTRAL] And for the year, it's 4.
[CUSTOMER][NEUTRAL] OK, one minute.
[AGENT][POSITIVE] Yes sir, take your time.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much for that and uh
[CUSTOMER][NEGATIVE] So the plane denied on.
[CUSTOMER][NEUTRAL] What day did this actually uh paid?
[AGENT][NEUTRAL] OK, let me show you, let me look that up real quick, the pay date.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, paid on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. And uh is it possible for you to help me with one more claim for the same member?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes, absolutely. What is the data service and the charge amount?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] $260 even.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look up this one and I'll be right back.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. So this one also paid $75. The claim number is 3579349.
[AGENT][NEUTRAL] The check number is 2034335 and the check did clear the bank on [PII].
[AGENT][NEUTRAL] And the claim was processed?
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEGATIVE] OK, so this is also the same issue. It is paid for 75 and the maximum benefits met and the two security codes are not paid.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you so much. And uh I have one more patient.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, this one is.
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII] with [PII].
[CUSTOMER][NEUTRAL] The policy number I have here is 0258.
[CUSTOMER][NEUTRAL] 07887.
[AGENT][NEUTRAL] OK, let me look him up.
[AGENT][NEUTRAL] OK, and what is [PII]'s date of service and charge amount?
[CUSTOMER][NEUTRAL] Um, it is for [PII] $160 even 60.
[AGENT][NEUTRAL] OK, and is it for the same facility?
[CUSTOMER][NEUTRAL] Yes, same facility.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, I'm gonna put you on a quick hold while I look this one up. I'll be right back with you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. So looking on [PII]'s file, his policy on data service of [PII], we do not find a claim on file for that date of service.
[CUSTOMER][NEUTRAL] The claim has been submitted on [PII], like the other claims.
[AGENT][NEUTRAL] OK, I do not find it on file at this time.
[CUSTOMER][NEUTRAL] Let me check that one moment.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][POSITIVE] No claims fall down.
[CUSTOMER][NEUTRAL] a minute.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] When it has been reached, the insurance.
[AGENT][NEUTRAL] OK, at this time it has not been processed, it's not showing up for me to be able to review it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So $160 bill amount, right? [PII], I'm sorry, [PII] $160.
[AGENT][NEUTRAL] Correct, I'm not finding the claim on file at this time.
[CUSTOMER][NEUTRAL] OK. Well, remember effective date?
[AGENT][NEUTRAL] The effective date of the policy is
[AGENT][NEUTRAL] [PII] and the policy is current and active.
[CUSTOMER][NEUTRAL] Family filing limit?
[AGENT][NEGATIVE] We do not have a timely filing limit.
[CUSTOMER][POSITIVE] OK, thank you so much. Can we get a call reference number?
[AGENT][NEUTRAL] Yes, sir. You can use my name, [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You're welcome, [PII] is.
[CUSTOMER][NEUTRAL] 58.
[AGENT][NEUTRAL] That, is that everything I can help you with today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, thank you so much for your patience.
[AGENT][POSITIVE] You're very welcome. I hope you have a wonderful Friday and weekend and thank you for calling APL.
[AGENT][NEUTRAL] Bye bye sir.
[CUSTOMER][POSITIVE] You too. Take care. Bye-bye.
[AGENT][NEUTRAL] Bye bye.