AccountId: 011433970860
ContactId: a37852b8-2988-4e33-8a18-9d51364ddadb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 331720 ms
Total Talk Time (AGENT): 119439 ms
Total Talk Time (CUSTOMER): 115280 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/a37852b8-2988-4e33-8a18-9d51364ddadb_20250528T20:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, this is [PII], and I'm with M Health Fairview and I'm just calling on a claim that we submitted for a patient.
[AGENT][NEUTRAL] OK, all right, Ms. [PII], I can help you with the claim. Um, may I please get your callback number, ma'am just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] It's [PII], date of birth [PII], and the policy number is 01954065ML8.
[AGENT][NEUTRAL] OK, let me look that up.
[AGENT][NEUTRAL] Alright thank you and then what's the data service and the charge amount?
[CUSTOMER][NEUTRAL] Data service is 1126 2024 and the total charged amount is $351.
[CUSTOMER][NEUTRAL] Looks like this is a roll over or it um it did process to you as secondary from Aetna.
[AGENT][NEUTRAL] Yes, ma'am. And then what was the charge amount after the primary paid their part?
[CUSTOMER][NEUTRAL] It looks like it's $40.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a quick hold, Ms. [PII], while I look up this claim for us and I'll be right back, ma'am.
[CUSTOMER][POSITIVE] OK. Awesome. Thank you so much.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much for holding for me, Ms. [PII]. I've got the claim information for you. The claim number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK awesome.
[AGENT][NEUTRAL] is 354.
[AGENT][NEUTRAL] 2717.
[AGENT][NEUTRAL] And the claim has been denied um for two reasons. One, office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then on the procedure G2211, it's not covered when performed in a physician's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, let me see that one here. So the 99213 you said isn't covered?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] When performed in our office visit setting.
[AGENT][NEUTRAL] No, that's the one that's um office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, then does it show then that the $40 is patient responsibility?
[AGENT][NEUTRAL] No ma'am, we don't give patient responsibility because we let the providers determine that and it's just because sometimes they give them discounts, sometimes they don't, so we just let them determine the patient responsibility.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, um, do you by chance have a, let me just see if I have a copy of the EOB that states that here.
[AGENT][NEUTRAL] Sure thing.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, yep, I do have it here. So I will definitely take care of that. I appreciate your help.
[AGENT][POSITIVE] Good.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Well, thank you, and I'm glad I was able to help you. I hope you have a good rest of your day. Is that everything I can help you with today?
[CUSTOMER][NEUTRAL] Very much.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK. Well, you take care.
[CUSTOMER][NEUTRAL] Yes, do you by chance?
[AGENT][NEUTRAL] Uh-huh. Yes, go ahead.
[CUSTOMER][NEUTRAL] Do do you have a reference number though for the call?
[AGENT][NEUTRAL] Yes, you can use my name [PII] in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Easy enough, awesome thanks a lot, [PII]. I appreciate that.
[AGENT][POSITIVE] You're very welcome. I hope you have a good, like I said, rest of your day and thank you for calling APL Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes, thank you. Take care.
[AGENT][NEUTRAL] You too. Bye-bye, ma'am.
[CUSTOMER][POSITIVE] Thank you yeah bye bye