AccountId: 011433970860
ContactId: a6b0a843-4ef3-4a8e-8915-6b55caa3da0a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 506100 ms
Total Talk Time (AGENT): 142909 ms
Total Talk Time (CUSTOMER): 108647 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/a6b0a843-4ef3-4a8e-8915-6b55caa3da0a_20250519T19:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII]. I'm calling from provider office and looking for claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Can I please get your callback number just in case the call's dropped?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Patient name is [PII] and date of birth is [PII].
[CUSTOMER][NEUTRAL] Member ID is 02451262.
[AGENT][NEUTRAL] OK, thank you. And then may I please uh get the member the I'm sorry, the facility name you're calling from?
[CUSTOMER][NEUTRAL] Uh yes, it's uh [PII] DO.
[AGENT][NEUTRAL] OK, and then what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Uh date of service ranges from [PII]. Bill amount is $1050.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look up this claim and I'll be right back.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. So looking on data service of [PII], I do not find a claim on file for the amounts that you have given me.
[CUSTOMER][NEUTRAL] Uh, actually, uh, I have a question on a claim. Actually, we received the denied your bill from
[CUSTOMER][NEUTRAL] Your side.
[AGENT][NEUTRAL] Oh, OK, what is that um claim number?
[CUSTOMER][NEUTRAL] Claim number is 3584929.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] Yes, this is the claim that I saw, but the amounts were different.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Let me look real quick.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, that is a good claim number and let me give you the the denial reason. Oh no, the, the claim number that you just gave me was a duplicate number.
[AGENT][NEUTRAL] Let me see if I can find it was a duplicate claim.
[AGENT][NEUTRAL] So let me see if I can find the original.
[AGENT][NEUTRAL] With the those amounts.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] For
[AGENT][NEUTRAL] OK, I've got it pulled up here. I have found the original claim number if you're ready I can give that to you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's 346-425-5.
[AGENT][NEGATIVE] And it has been denied.
[CUSTOMER][NEUTRAL] There's
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] The policy does not provide benefits for charges made by the doctor for inpatient visits.
[AGENT][NEUTRAL] So it's non-covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, is it, uh, is it not covered under the patient plan?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mm, OK. So, uh, can we bill the patient?
[AGENT][NEUTRAL] We don't give patient responsibility we let the provider determine that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, you said, uh, it's a non-covered charge. Is it not covered under the patient plan or provider?
[AGENT][NEUTRAL] It's not covered under the patient's plan.
[CUSTOMER][NEUTRAL] So we can pay the bill to patient, right?
[AGENT][NEUTRAL] That's determined by the provider.
[CUSTOMER][NEUTRAL] OK. And uh last time we submitted the corrected claim by changing the code from 99233299222. And uh why denied for a duplicate?
[CUSTOMER][NEUTRAL] As we submitted the corrected claim.
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] It was submitted again.
[AGENT][NEUTRAL] Twice.
[CUSTOMER][NEUTRAL] But this time we changed the CPT code.
[AGENT][NEUTRAL] Well, when you changed the CPT code, did you put a letter stating why you were changing it for correction?
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEGATIVE] Otherwise it's fraud.
[AGENT][NEUTRAL] If you don't include a letter then we have to use the original claim because if we just change CPT codes that's fraud.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][POSITIVE] OK, thank you so much. Uh, can you please provide me your reference number?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK. OK, thank you so much, [PII]. That's all for today and have a good day.
[AGENT][POSITIVE] You too, Ms. [PII]. You have a good week and thank you for calling APL.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Bye-bye. Thank you.