AccountId: 011433970860
ContactId: 991e97ad-46fa-46cd-8fe0-cd3af7390308
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 374679 ms
Total Talk Time (AGENT): 129730 ms
Total Talk Time (CUSTOMER): 110388 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/991e97ad-46fa-46cd-8fe0-cd3af7390308_20250528T14:16_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Allegheny Clinic to verify the claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you and your name is again?
[CUSTOMER][NEUTRAL] Mo [PII].
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, thank you. And Ms. [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] So the policy number would be 02519675.
[AGENT][NEUTRAL] Thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] The patient name would be uh [PII] and the date of birth would be [PII].
[AGENT][NEUTRAL] OK, thank you. And give me one moment. And what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] The date of service would be [PII] and the total charge amount would be $24 even.
[AGENT][NEUTRAL] The total charge amount is $24.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment. And while I'm looking up claim information, just to let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the name of the provider's office is?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The Allegheny Clinic.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] What was the procedure code for this data service?
[CUSTOMER][NEUTRAL] The uh procedure code would be 71045.
[CUSTOMER][NEUTRAL] Any
[AGENT][NEUTRAL] I'm sorry, give that to me one more time.
[CUSTOMER][NEUTRAL] 71045.
[AGENT][NEUTRAL] OK, I show that claim process as uh benefits payable only as primary pays.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, uh, actually we got, uh, UBS the claim was duplicate.
[CUSTOMER][NEUTRAL] And uh verify that.
[AGENT][NEUTRAL] Correct, because we received it previously uh as uh benefits payable only if primary pays.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please repeat it again?
[AGENT][NEUTRAL] The claim processed as benefits payable only if the primary pays.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So is it as per the uh patient policy, uh, the primary should be paid for this one?
[AGENT][NEUTRAL] What that means is we are secondary. As secondary, we only pick up what primary applies towards deductible, co-pay, and or co-insurance. For this claim, part of the EOB received, it does not show primary applied any amounts towards deductible, co-pay, or co-insurance, so there's nothing for us to pick up and pay. So benefits payable only if primary pays.
[CUSTOMER][NEUTRAL] No, I just
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So, uh, you only paid only the primary paid, then only you would pay them, right?
[AGENT][NEUTRAL] We only pick up what primary applies towards deductible, co-payer, or co-insurance. So if the provider or primary does not apply anything towards that, then it is not paid.
[CUSTOMER][NEUTRAL] OK, give me a moment please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Uh, thank you so much for your patience. OK, thank you so much for your information. I will check with the primary payer and uh call back to you. Thank you.
[AGENT][NEUTRAL] OK, uh, is there anything else, Ms. [PII], I can assist you with today?
[CUSTOMER][NEUTRAL] No, that's all for the day. Thanks for asking me. May I know the call reference number?
[AGENT][NEUTRAL] Uh, you may use my name at today's date.
[CUSTOMER][NEUTRAL] Yeah, could you please spell out your name?
[AGENT][NEUTRAL] Sure. [PII].
[CUSTOMER][POSITIVE] Yeah, thank you so much have a great day bye bye.
[AGENT][POSITIVE] You're welcome thanks for calling APL bye.