AccountId: 011433970860
ContactId: 976333dc-8a7a-4d70-99c9-7c61b8998b9e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 505920 ms
Total Talk Time (AGENT): 87051 ms
Total Talk Time (CUSTOMER): 231124 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/976333dc-8a7a-4d70-99c9-7c61b8998b9e_20250520T13:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] and the last name initial [PII]. Could you please remind me your name spelling, please?
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][POSITIVE] Yeah, yeah, thank you, [PII] and last name initial, please.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yeah, thank you [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] How can I help you today?
[CUSTOMER][NEUTRAL] Yeah, uh, we got a correspondence in that, uh.
[CUSTOMER][NEUTRAL] We're billed with two procedure codes and we got paid only one procedure code but uh asking for the patient they're not covered by this payer. Could you please check once?
[AGENT][NEUTRAL] OK, sure, I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII] with an extension [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You have the policy number for the patient.
[CUSTOMER][NEUTRAL] Sure. 02399312.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um [PII]
[AGENT][NEUTRAL] And do you have the account number?
[CUSTOMER][NEUTRAL] You want the claim number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, one sec.
[CUSTOMER][NEUTRAL] The claim number.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] 3,553,290
[AGENT][NEUTRAL] OK, looks like that was the original claim we were requesting primary explanation of benefits.
[CUSTOMER][NEUTRAL] Maybe.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] 062233-030
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, it looks like we made a payment of $25 and you're asking why we didn't pay the other charge, is that right?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] And the maximum benefit amount for treatment provided during the office visit was exhausted, dollar amount.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK let me just
[AGENT][NEGATIVE] No benefits were payable.
[CUSTOMER][MIXED] OK, maximum benefits as per dollar wise exhausted. OK, exhausted.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What is the maximum benefits uh uh for this patient?
[CUSTOMER][NEUTRAL] As per dollar wise.
[AGENT][NEUTRAL] Uh, it looks like $25.
[CUSTOMER][NEUTRAL] Only $25?
[AGENT][NEUTRAL] Yeah let me pull up the policy.
[CUSTOMER][NEUTRAL] Me.
[CUSTOMER][NEUTRAL] Uh, I don't know, because Medicare has stated that the claim is called for coordination of benefits.
[CUSTOMER][NEUTRAL] Can you verify that, uh, can you just verify, uh, for the patient, is this a primary insurance is a medical supplement?
[AGENT][NEUTRAL] Yeah, physician outpatient treatment benefits pay a maximum of $25.
[CUSTOMER][NEUTRAL] Treatment benefits is maximum of $25. OK. It's for uh for per day or throughout the per plan.
[AGENT][NEUTRAL] Or visit.
[AGENT][NEUTRAL] It, it's
[CUSTOMER][NEUTRAL] For a visit.
[AGENT][NEUTRAL] For visit, yeah.
[CUSTOMER][NEUTRAL] OK, we can bill only to $25. I think we billed with uh 88305 and 88312, right?
[AGENT][NEUTRAL] Those were the CPT codes billed. Yes, that was what was submitted.
[CUSTOMER][NEUTRAL] Yes, uh, I, I think, uh, we have appended the modifiers 26 for each one.
[CUSTOMER][NEUTRAL] So should I repeat that again?
[AGENT][NEUTRAL] OK. What, what's your question?
[CUSTOMER][NEUTRAL] Uh, one second, I'll check. One moment please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, procedure weekly dialing monthly has been expression.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] OK, what could be the remaining amount, uh, it is it a patient responsibility or uh the providers uh discount?
[AGENT][NEUTRAL] Uh, we can't instruct on patient responsibility. It's a secondary policy.
[CUSTOMER][NEUTRAL] Oh, is it a secondary policy?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] You need the primary UOB?
[AGENT][NEUTRAL] Well, we've already processed the claim. Uh, it looks like we
[AGENT][NEUTRAL] Received it. Let me see.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Uh, normally we need the primary EOB, but I show this just pays a flat 25.
[AGENT][NEUTRAL] Are you there?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Oh sorry, I was on mute. Uh, if in case if you bills to the primary will be and the process, uh, and paid and the leftover could be the secondary, and if, if you, you are the secondary, so if in case the primary paid and leftover could be paid by you or only this much of amount you are going to pay.
[AGENT][NEUTRAL] We will only pay a max of 25.
[CUSTOMER][NEUTRAL] In
[CUSTOMER][NEUTRAL] You only pay max 25.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, Max 25, right, thank you. And um may I have a call reference, please?
[AGENT][NEUTRAL] That's my name is [PII], first initial [PII], and then today's date.
[CUSTOMER][POSITIVE] Today's date [PII]. Right, thank you. Have a great day. Bye-bye.
[AGENT][POSITIVE] Thank you for calling APL. You as well. Bye bye.