AccountId: 011433970860
ContactId: 9a964d7b-2ebe-407e-8882-6256a2bc1de7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 845090 ms
Total Talk Time (AGENT): 221892 ms
Total Talk Time (CUSTOMER): 200286 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/9a964d7b-2ebe-407e-8882-6256a2bc1de7_20250310T13:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII], and I am calling to check claim status.
[AGENT][NEUTRAL] I can help you a little more. What's the policy number?
[CUSTOMER][NEUTRAL] Yes, this policy number here would be 022.
[CUSTOMER][NEUTRAL] 658-71
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And verify the patient's name and date of birth, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] Alright, thank you for that information, [PII], and you said that you're checking claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the data service in charge?
[CUSTOMER][NEUTRAL] Data service for this claim is 12-6-2024.
[CUSTOMER][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] would be
[CUSTOMER][NEUTRAL] $681.
[AGENT][NEUTRAL] You're calling from a provider's office?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this claim was processed on [PII]. Um, the 77067 and 77063 looks like they're coded as wellness, which is not covered under the policy, and then the 76641 uh treatment in the office is not covered under this policy, so no payment was made. Um, I do have a claim number. Let me know when you're ready.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] That that number is 356-414-4.
[AGENT][NEUTRAL] And [PII], you can also check status online at [PII]. And did you have any other questions I could help out with today?
[CUSTOMER][NEUTRAL] I do have others.
[AGENT][NEUTRAL] For this patient?
[CUSTOMER][NEUTRAL] Different member, so you said that this claim denied on [PII] due to services not payable?
[AGENT][NEUTRAL] Not covered by the patient's policy.
[AGENT][POSITIVE] And I'm ready for the next
[CUSTOMER][NEUTRAL] Is this patient's responsibility?
[AGENT][NEUTRAL] We do not determine patients responsibility, ma'am. We're just letting you know that it's not covered by their policy.
[CUSTOMER][NEUTRAL] OK, this next one here, member ID 02116.
[CUSTOMER][NEUTRAL] 622.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] Um, date of birth, [PII].
[AGENT][NEUTRAL] Take a service in charge?
[CUSTOMER][NEUTRAL] Data service would be 11-11-2024.
[CUSTOMER][NEUTRAL] And the total bill 1,262.
[AGENT][NEUTRAL] What are the procedure codes on that claim?
[CUSTOMER][NEUTRAL] 76641
[AGENT][NEUTRAL] Is that the only the only code?
[CUSTOMER][NEUTRAL] Oh, also 77066 and G 0279. Sorry about that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And did you build left and right for the 766-41?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So for the ultrasound I'm showing that for each of those codes a payment of $61.19 was paid, so the total check received is 122.38.
[AGENT][NEUTRAL] And then on the other two codes uh on this claim.
[AGENT][NEUTRAL] There was no payment made. It looks like the.
[AGENT][NEUTRAL] Um, primary insurance pay those in full.
[CUSTOMER][NEUTRAL] OK, and you said it was 61?
[AGENT][NEUTRAL] 6119 per code and the check total.
[CUSTOMER][NEUTRAL] 19.
[AGENT][NEUTRAL] Mhm. It's 122.38.
[AGENT][NEUTRAL] Let me know when you're ready for the claim number. That number is 353-9934.
[CUSTOMER][NEUTRAL] OK, claim number.
[AGENT][NEUTRAL] Any any other questions?
[CUSTOMER][NEUTRAL] EFT or check number.
[AGENT][NEUTRAL] It's an individual check number 2017827.
[CUSTOMER][NEUTRAL] And what is your name?
[AGENT][NEUTRAL] Please use my name in today's date as reference for today's call [PII], first initial last name is [PII].
[CUSTOMER][NEUTRAL] OK, [PII], I do have 2 more. Are you able to help me with those?
[AGENT][NEUTRAL] OK, and I can also show you how to set the account up and you can check your status online either way.
[CUSTOMER][NEUTRAL] Uh, I'm not able to set the account up. It would have to come from up above. That's the only reason why I'm calling because normally I would have set it up.
[AGENT][NEUTRAL] OK, is it
[AGENT][NEUTRAL] Is it for the same person or different patient?
[CUSTOMER][NEUTRAL] a different patient.
[AGENT][NEUTRAL] OK give me one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And what is the next policy number? Go ahead and give me both policy numbers.
[CUSTOMER][NEUTRAL] OK, 02.
[CUSTOMER][NEUTRAL] 176905
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then the other one is 022.
[CUSTOMER][NEUTRAL] 631-80.
[AGENT][NEUTRAL] Verify the patient's name and date of birth for 217-69-05.
[CUSTOMER][NEUTRAL] Yes, that patient's name is.
[CUSTOMER][NEUTRAL] 00 goodness. [PII]
[CUSTOMER][NEUTRAL] No, [PII], I don't know how to pronounce it, and the last name is [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Sorry about that.
[AGENT][NEUTRAL] Mhm. And date of birth.
[CUSTOMER][NEUTRAL] Date of birth would be [PII].
[AGENT][NEUTRAL] The date of service in charge?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Total amount billed.
[CUSTOMER][NEUTRAL] would be $1,012.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You said 1,012?
[CUSTOMER][NEUTRAL] $1,012 yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm showing a payment of $159.96 was issued on [PII].
[AGENT][NEUTRAL] I'm showing a claim number of 356.
[AGENT][NEUTRAL] 5708.
[AGENT][NEUTRAL] And an individual check number?
[AGENT][NEUTRAL] 202.
[AGENT][NEUTRAL] 86866.
[CUSTOMER][NEUTRAL] And so this pay 15996.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And verify the patient's name and date of birth for [PII]. Looks like there's one too many numbers. Do you have the card?
[AGENT][NEUTRAL] Let me, let me do, let me do that again.
[CUSTOMER][NEUTRAL] Um, one moment
[CUSTOMER][NEUTRAL] I'm gonna open this account up.
[AGENT][NEUTRAL] Yeah, that may be correct. Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes, ma'am. Patient's name is [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Date of birth for this number here.
[CUSTOMER][NEUTRAL] would be
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, the date of service?
[CUSTOMER][NEUTRAL] Data service is [PII].
[AGENT][NEUTRAL] And the amount?
[CUSTOMER][NEUTRAL] Total bill amount for this claim would be.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] $831.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] This claim was processed on [PII].
[AGENT][NEGATIVE] And it denied um the EOB submitted with the claim doesn't match the itemized bill.
[AGENT][NEUTRAL] So we're needing the explanation, the primary explanation of benefits that that matches the the CMS 1500 form.
[CUSTOMER][NEUTRAL] Denied on what date?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The claim number?
[AGENT][NEUTRAL] Is 351-660-9.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Primary EOB doesn't match services bills.
[AGENT][NEUTRAL] Does it match the the the claim bill the itemized bill?
[AGENT][NEUTRAL] Any other questions I can assist with today [PII]?
[CUSTOMER][POSITIVE] No, ma'am, that would be all. I appreciate you so much. Have a wonderful week.
[AGENT][POSITIVE] Oh, you're welcome. Thank you.
[AGENT][POSITIVE] You too. Thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye bye.