AccountId: 011433970860
ContactId: 94cba789-4b33-4562-852b-338e3f920483
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 380730 ms
Total Talk Time (AGENT): 172005 ms
Total Talk Time (CUSTOMER): 81833 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/94cba789-4b33-4562-852b-338e3f920483_20250623T19:46_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. I'm calling from Carolina Cardiology in reference to the status of a claim on a member.
[AGENT][NEUTRAL] OK, [PII], you have one patient to Trinity and you can claim status on, is that correct?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] My direct number is [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] That is.
[CUSTOMER][NEUTRAL] 02569253
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] And any information [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's for um [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] Um, one data service, two claims. The first, uh, one is for [PII]. The charge amount is $1,685.
[AGENT][NEUTRAL] $1,685 for [PII], is that correct?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this claim was received, the received date was [PII]. It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 3614682.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $500.
[AGENT][NEUTRAL] And that was paid on check number, single check, 2051025.
[AGENT][NEUTRAL] And the remarks on this claim, [PII], first off, that was on code 78452 that the benefit was paid.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it states with this check, the maximum benefit payable for this state of service has been met.
[CUSTOMER][NEUTRAL] Got it. Is there a patient responsibility on that?
[AGENT][NEUTRAL] And the
[AGENT][NEUTRAL] We do not determine patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] Got it, um, and this check was issued when?
[AGENT][NEUTRAL] And we do have a
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] All right. You were about to say before I interrupt you?
[AGENT][NEUTRAL] Oh, that's OK. No, go ahead if you have any other questions, I can still tell you what I was going to.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Go ahead, please.
[AGENT][NEUTRAL] Mhm. OK. I was just gonna say if you need a copy of, there is, should be a copy of that explanation of benefits along with the check, uh, being mailed, but you can also print it now that you have the claim number by going to our portal, which is located at secured.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Got it thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Um, on, on the same number, same date of service charge amount is 233.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so that was part of the same, oh, no, I'm sorry. Give me just one.
[CUSTOMER][POSITIVE] You're OK.
[CUSTOMER][NEUTRAL] the
[AGENT][NEGATIVE] So this claim was also received and the received date on it was also [PII] and it was processed and denied on [PII].
[AGENT][NEUTRAL] And the claim number is 361.
[AGENT][NEUTRAL] 363 8.
[CUSTOMER][NEUTRAL] And so you mentioned denied and so.
[AGENT][NEUTRAL] Oh, and this claim was denied as, this one was denied as office visits are not covered by the policy?
[CUSTOMER][NEUTRAL] Oh it's not.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] It, oh, so what, what does this policy cover?
[AGENT][NEUTRAL] It has benefits for a lot of different outpatient services, but an office visit is not one.
[CUSTOMER][NEUTRAL] Got it. Alright, [PII], do you give a reference number?
[AGENT][NEUTRAL] Yes, like we can review for treatment done in the office, but the office visit fee itself is not covered.
[CUSTOMER][POSITIVE] Got it, that's good to know.
[CUSTOMER][POSITIVE] Alright, thank you for that information and I will take your reference number if you have one whenever you're ready.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] You would use my name along with today's date.
[CUSTOMER][POSITIVE] Awesome thank you have a blessed rest of your day, OK?
[AGENT][POSITIVE] Oh well I hope you do too, and if that is all that I could help you with, thank you again for calling APL today [PII].
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Uh-huh, bye-bye.