AccountId: 011433970860
ContactId: a6c9b28e-3f8d-4198-8ab1-4f2dfe4aa35a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1087939 ms
Total Talk Time (AGENT): 350812 ms
Total Talk Time (CUSTOMER): 139933 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/a6c9b28e-3f8d-4198-8ab1-4f2dfe4aa35a_20250115T13:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, Ms. [PII] calling from the provider's office to check claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes sir, I can help you with that in mind. What is your callback number, please?
[CUSTOMER][NEUTRAL] The callback number is [PII].
[AGENT][NEUTRAL] Thank you. And how many claims do you have to check status on Rome?
[CUSTOMER][NEUTRAL] Yeah, this one. Can you spell your name for documentation purposes?
[AGENT][NEUTRAL] [PII] and my name will also be your call reference number along with today's date.
[AGENT][NEUTRAL] And [PII], what is your patient's policy?
[CUSTOMER][NEUTRAL] Can you spell it again?
[CUSTOMER][NEUTRAL] Can you spell it again? [PII]?
[AGENT][NEUTRAL] No, sir.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] R
[AGENT][NEUTRAL] A C
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your patient's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Just a minute.
[CUSTOMER][NEUTRAL] It's 02544684.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any information [PII] that I provide today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please, Ryan?
[CUSTOMER][NEUTRAL] And data services.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] What is the total bill amount?
[CUSTOMER][NEUTRAL] $26 even.
[AGENT][NEUTRAL] One moment, please.
[AGENT][NEUTRAL] OK, so this claim was received on a
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Process on [PII].
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 958 9.
[AGENT][NEUTRAL] And this claim was denied, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Vena puncture is not covered by this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We already requested the U be on [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Still, we didn't see that you will be updated you will be.
[AGENT][NEUTRAL] OK, and so [PII], you can also print this yourself if you didn't receive it, um.
[AGENT][NEUTRAL] From APL by going to our portal at [PII].
[AGENT][NEUTRAL] And using the claim number?
[AGENT][NEUTRAL] I can try and fax it to you one more time, but if you for some reason do not receive it this way, then you would need to print it from our portal.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is your fax number, [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Does it need to be put to your attention?
[CUSTOMER][NEUTRAL] It's attention to your name.
[AGENT][NEUTRAL] I'm sorry, to your name? OK, so just one.
[CUSTOMER][NEUTRAL] To my name.
[CUSTOMER][NEUTRAL] And that is, yeah, my name, [PII].
[AGENT][NEUTRAL] So just one moment while the information is loading please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's still loading.
[AGENT][NEUTRAL] And again, you said that your fax number is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][POSITIVE] OK, [PII]. So this has been faxed to you, so provided that you're able to receive it and there's not any type of technical problem, then you should be receiving this within uh the next few minutes.
[CUSTOMER][POSITIVE] Mhm. OK. Take your time.
[AGENT][NEUTRAL] OK. Is there anything, I have already faxed it. So is there anything else I can help you with this morning?
[CUSTOMER][NEUTRAL] So how many days will be you will be, be received?
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] How many days will you be?
[AGENT][NEGATIVE] [PII], I can't understand what you're saying. Your voice sounds, it's not where I can understand you.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. How many days that the UP will be received to?
[CUSTOMER][NEUTRAL] No fax.
[AGENT][NEUTRAL] Yeah, I can't tell you a specific number of minutes.
[AGENT][NEUTRAL] It has already been sent. I sent it to that fax number.
[AGENT][NEUTRAL] So you should be receiving it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Within the next few minutes.
[AGENT][NEUTRAL] I would say less than 10 minutes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If it will go through.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But it has been sent. Again, if it does not come through this time, you will need to print it from our portal by going to that website that I gave to you.
[CUSTOMER][NEUTRAL] OK, can.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] No, sir.
[AGENT][NEUTRAL] I gave you secured. [PII].
[CUSTOMER][POSITIVE] Secure.
[AGENT][NEUTRAL] With a D on it, uh-huh, secured with, make sure you put a D on the end of that word. [PII].
[CUSTOMER][NEUTRAL] [PII] yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Can you help me with another client with the same patient?
[AGENT][NEUTRAL] [PII], you said that you had one claim.
[AGENT][NEUTRAL] You have another date service? How many dates of service do you have for this member?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Only 2. The first one is already given and this is the 2nd 1.
[AGENT][NEUTRAL] Sure, I can help you with that as well and also on this one, any information that I provide will be a verification of benefits and not a guarantee of payment. What is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] And the date of service is [PII]. And the bill amount is $691 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] $691 for [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] This claim was received on [PII], processed on [PII].
[AGENT][NEUTRAL] The claim number is 354.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0, it says, OK, before I give you this claim number, I just received a confirmation that the fax was successfully sent.
[AGENT][NEUTRAL] So the claim number for the data service is 354-047-4.
[CUSTOMER][NEUTRAL] It's 354-047-4, right?
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] That is correct. There has been a $50 benefit paid.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On this claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On single check, 202.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 0755.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on this claim?
[AGENT][POSITIVE] That benefit was paid.
[AGENT][NEUTRAL] On code 99214.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it states with this check the maximum benefit payable for this data service.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the other code was denied stating the maximum benefit payable for this state of service has been met.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] $50 is the maximum benefit payable for this data service.
[CUSTOMER][NEUTRAL] $50 is the maximum payable amount, right, for the CPT 76816.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] No, no, for code 99 for the state of service. So we pay $50 on the code 99214.
[CUSTOMER][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And the rest of that charge was not covered because it was the maximum benefit [PII]ble was met. And then the 76816, there was nothing paid on it because the maximum benefit had already been met for this data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This is not major medical insurance. It's a limited benefit plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] We also requested the UP for this one also, but we still didn't receive that.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And who did you speak with, [PII]?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What is the name of the person that you spoke with?
[AGENT][NEUTRAL] When you requested this EOB be faxed?
[CUSTOMER][NEUTRAL] And the rep name is [PII]. And the last initial is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK just one moment while this is pulling up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it's still trying to load the COB.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the COB has also been faxed to you, [PII]. Is there anything else I can help you with this morning?
[CUSTOMER][NEGATIVE] Uh no.
[CUSTOMER][POSITIVE] Thank you for your help. Have a good day.
[AGENT][NEUTRAL] OK, well then.
[AGENT][POSITIVE] You're very welcome and thank you for calling APL and I hope you have a great day as well.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][POSITIVE] Mhm. Thank you. Bye-bye.
[AGENT][POSITIVE] Uh-huh. You're welcome. Bye-bye.