AccountId: 011433970860
ContactId: a1d0c959-827a-40f3-9408-7c65a770ca7f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409059 ms
Total Talk Time (AGENT): 78849 ms
Total Talk Time (CUSTOMER): 184389 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/a1d0c959-827a-40f3-9408-7c65a770ca7f_20250520T15:38_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hey, hi, hi. Uh, this is [PII] calling from provider's office, looking for the claims information.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Um, do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the patient policy number?
[CUSTOMER][NEUTRAL] And the policy number, uh, would be 02509857.
[AGENT][NEUTRAL] Patient name and date of birth.
[CUSTOMER][NEUTRAL] The patient's first name is uh [PII] and the last name is [PII] and the date of birth would be uh [PII].
[AGENT][NEUTRAL] And date of service and bill charges?
[CUSTOMER][NEUTRAL] It's uh [PII] and the bill amount is $2,467.
[CUSTOMER][POSITIVE] The weather is very colorful.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And we uh yeah uh actually so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, looks like we received that claim.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] OK, received on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We made a payment of 336 46.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] And do you need the check number or what information do you need?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So, uh,
[CUSTOMER][NEUTRAL] I do see that the uh security code [PII] has been not paid and it was uh denied as the uh maximum benefits for this date of service has been met. And I do see that the uh CPD code 88312.
[CUSTOMER][NEUTRAL] Like, uh, we got the uh less payment around 47. 1616 cents and um
[CUSTOMER][NEUTRAL] I need the uh clarity on this denial reason.
[AGENT][NEUTRAL] OK, you need the denial reason for which one?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] For a CPT code 88313 and 88312.
[AGENT][NEUTRAL] It was the maximum benefit payable for data service was met.
[CUSTOMER][NEUTRAL] Every.
[AGENT][NEUTRAL] On each one.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] What was the, uh, is it under the uh dollar value or else the units value?
[AGENT][POSITIVE] Dollar value.
[CUSTOMER][NEUTRAL] What was the dollar amount of that patient has uh supposed to make?
[CUSTOMER][NEUTRAL] Are you there?
[AGENT][NEUTRAL] About $1000 calendar year maximum.
[CUSTOMER][NEUTRAL] $1000.
[CUSTOMER][NEUTRAL] $1000 per per year, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] When was it was, when was it was me?
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] The balance would, would be the patient's responsibility.
[AGENT][NEUTRAL] Um, this is a secondary policy, so we can't instruct on patient responsibility.
[CUSTOMER][NEUTRAL] Sorry, can you repeat that sentence once again?
[AGENT][NEUTRAL] This is a secondary policy, we cannot instruct on patient responsibility, so we, we can't tell you if it's patient responsibility. We just can process the claim according to the policy.
[CUSTOMER][NEUTRAL] OK. May I know the time the filing limit?
[AGENT][NEGATIVE] There's no timely filing limit.
[AGENT][NEUTRAL] Or did you say appeals?
[CUSTOMER][NEUTRAL] Yes, how can we append this claim?
[CUSTOMER][NEUTRAL] With the patient's medical records.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, our appeal timely filing is 180 days from process date.
[CUSTOMER][NEUTRAL] 180 days from the process that uh which is.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Can we appeal this claim?
[AGENT][NEUTRAL] It it's up to you if you'd like to appeal it. I, I mean, I can't instruct you on whether to appeal it or not.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] None of the call reference number.
[AGENT][NEUTRAL] Uh, it's my name is [PII], and today's date.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much. Have a great day.
[AGENT][POSITIVE] Thanks for calling APL. You as well. Bye-bye.