AccountId: 011433970860
ContactId: a502448a-0c49-4b93-857b-dced6ef72f39
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 324980 ms
Total Talk Time (AGENT): 107219 ms
Total Talk Time (CUSTOMER): 87104 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/a502448a-0c49-4b93-857b-dced6ef72f39_20250530T20:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office. I'm checking about a claim.
[AGENT][NEUTRAL] OK, yeah, I could check a claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, the callback number is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Sure. The policy number is D as in David 43222952.
[AGENT][NEUTRAL] OK, so [PII], that's not one of our policy numbers that is through, uh, they're called 90 degree Benefits. Uh, if you'd like I can give you their phone number and transfer you to them, um, or if you have the member's social, I can see if they do have a policy with us.
[CUSTOMER][NEUTRAL] That's true.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, once again.
[CUSTOMER][NEUTRAL] Yeah, the social is [PII].
[AGENT][NEUTRAL] Could you repeat that? I'm sorry.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what was the name for the member?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, do you have the date of birth?
[CUSTOMER][NEUTRAL] Sure. It's on [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. uh, I did find a policy that they have with us uh what was the date of service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's on [PII].
[AGENT][NEUTRAL] [PII], OK, and then, uh, what was that bill amount, please?
[CUSTOMER][NEUTRAL] $343.25.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII], what was the uh tax ID for this provider?
[CUSTOMER][NEUTRAL] Sure, the tax ID number is [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, so, uh, we did receive this claim, [PII], it looks like we paid a benefit of $100 even.
[CUSTOMER][NEUTRAL] OK. I do have a specific concerns regarding this claim.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I just wanted to know why the code, yeah, I wanted to know why the code 82962 and 93,000 was denied. So can you please help me with that?
[AGENT][NEUTRAL] Sure, so we only paid on the one code that was um let's see 99,240 the $100 met their maximum for this date of service.
[AGENT][NEGATIVE] So we were just simply unable to pay any more on any of the other codes, not because they were not covered, but because they reached that $100 limit.
[CUSTOMER][NEUTRAL] OK, so I just wanted to know, so for uh the dollar amount per day for the patient is $100 and you have already paid for that $100 right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. So the, so is this available to patients?
[AGENT][POSITIVE] Say that again, I'm so sorry.
[CUSTOMER][NEUTRAL] So, can we build the rest of the CPT to the patient?
[AGENT][NEUTRAL] Uh, so we don't say what is patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] OK, and I'm sorry, I missed your name. You said your name is?
[AGENT][NEUTRAL] Uh, [PII], it's [PII].
[AGENT][NEUTRAL] Was there anything else I could help you with [PII]?
[CUSTOMER][NEUTRAL] Can I have the claim number?
[AGENT][NEUTRAL] Yes, that is uh 35.
[AGENT][NEUTRAL] 65.
[AGENT][NEUTRAL] 310.
[CUSTOMER][NEUTRAL] Sure, so for your call today.
[AGENT][NEUTRAL] Reference number would just be my first name, last initial and today's date, uh, so my last initial is [PII]
[CUSTOMER][POSITIVE] Sure, thank you so much for your assistance. Have a great day bye bye.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Oh