AccountId: 011433970860
ContactId: a4069ed3-5018-4760-8547-35689941325b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 494920 ms
Total Talk Time (AGENT): 98894 ms
Total Talk Time (CUSTOMER): 200118 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/26/a4069ed3-5018-4760-8547-35689941325b_20250626T15:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I call from the Center for Bonene and Joint Surgery of the Palm Beaches. I have a question for claim status.
[AGENT][NEUTRAL] Hi, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, uh [PII].
[CUSTOMER][NEUTRAL] [PII] didn't mind.
[AGENT][NEUTRAL] OK, thank you. And the policy number for the patient?
[CUSTOMER][NEUTRAL] Yeah, it's 021.
[CUSTOMER][NEUTRAL] 97
[CUSTOMER][NEUTRAL] 552.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, and what is that date of service and bill charges?
[CUSTOMER][NEUTRAL] The data service is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the bill amount.
[CUSTOMER][NEUTRAL] 458.46 cents.
[AGENT][NEUTRAL] OK, you said [PII]?
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] Uh, I've got a claim for 343-86.
[AGENT][NEUTRAL] For office visit?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, uh, you gave me a different bill amount, so I, I just wanna make sure that's the right one.
[CUSTOMER][NEUTRAL] Uh, the development is 458.46 N.
[AGENT][NEUTRAL] OK, I, that's what I said. I have a claim for that date, but it's not for that amount. It's for 343-86. Is this the right claim? CPT 99203?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] 343. Mm.
[CUSTOMER][NEUTRAL] I don't know what happened because in my system I see 458.46.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] You have the code? What code is it billing with?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Is there a CPT code on there or a procedure code?
[CUSTOMER][NEUTRAL] Yeah, the CPT is 99203.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] Um, so it looks like we received the claim on.
[CUSTOMER][NEUTRAL] When did you last?
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] 62 2025.
[AGENT][NEUTRAL] Process 65 2025.
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And claim was denied, office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII] I.
[CUSTOMER][NEUTRAL] OK. So, obviously this is not covered.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, yeah, we have to date we have it at [PII].
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Do
[CUSTOMER][NEUTRAL] Um, can I give you, I'm sorry, can I give you the other patient?
[AGENT][NEUTRAL] Uh, yes, you have a different claim status, is that right?
[CUSTOMER][NEUTRAL] Uh, yeah.
[AGENT][NEUTRAL] OK, the policy number?
[CUSTOMER][NEUTRAL] One sec.
[CUSTOMER][NEUTRAL] Yeah, one second, um.
[CUSTOMER][NEUTRAL] OK, the policy number is 24.
[CUSTOMER][NEUTRAL] 210. 0, OK, so uh you'll need to take it up where I am. I'm in.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Oh, was that all 24,210?
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] 24,210, yeah, correct.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] I'm not pulling up anything under that policy number. Do you have the last name of the patient or the social?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And the patient's name is [PII].
[AGENT][NEUTRAL] OK. How do you spell the last name?
[CUSTOMER][NEUTRAL] Yeah. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK. Give me just a moment.
[CUSTOMER][POSITIVE] Mm thank you.
[AGENT][NEUTRAL] OK. Do you have her date of birth?
[CUSTOMER][NEUTRAL] Yeah, the date of it is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And date of service and bill charges?
[CUSTOMER][NEUTRAL] Yeah, one second.
[CUSTOMER][NEUTRAL] Yeah, the service is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the bill charges?
[CUSTOMER][NEUTRAL] 936.25 cents.
[AGENT][NEUTRAL] Uh, it looks like we don't have the claim on file. Can you resubmit that?
[CUSTOMER][NEUTRAL] Um, one second.
[CUSTOMER][NEUTRAL] And do you need the
[CUSTOMER][NEUTRAL] Claim ID.
[CUSTOMER][NEUTRAL] I'm it is the claim number?
[AGENT][NEUTRAL] It
[CUSTOMER][NEUTRAL] Maybe.
[AGENT][NEUTRAL] You have the claim number?
[CUSTOMER][NEUTRAL] Yeah, I have.
[CUSTOMER][NEUTRAL] M as Mike.
[CUSTOMER][NEUTRAL] 001
[CUSTOMER][NEUTRAL] R1.
[CUSTOMER][NEUTRAL] Number 8 688.
[CUSTOMER][NEUTRAL] 56.
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] 24
[AGENT][NEUTRAL] OK, that's not one of our claim numbers.
[AGENT][NEUTRAL] So this is a secondary policy, so that might be the primary, I'm not sure.
[AGENT][NEUTRAL] But I don't, I don't show a claim on file with us for that date of service with those charges.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] OK, no problem. Uh, I'm sorry. Can you repeat your name one more time?
[AGENT][NEUTRAL] It's [PII], first initial and last name, [PII].
[CUSTOMER][NEUTRAL] And your reference number for this call?
[AGENT][NEUTRAL] It's my name in today's date.
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you for your help.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.