AccountId: 011433970860
ContactId: a835dd88-a55d-479d-9a37-768e3266b888
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 472420 ms
Total Talk Time (AGENT): 131312 ms
Total Talk Time (CUSTOMER): 125595 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/a835dd88-a55d-479d-9a37-768e3266b888_20250103T16:38_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII] and I'm calling from Prisma Health. Um, are you able to help me look up two claims?
[AGENT][POSITIVE] Sure, I'd be happy to assist.
[CUSTOMER][NEUTRAL] For claim status? OK.
[AGENT][NEUTRAL] With claims today, um, if I can get a good call back number for you?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] And [PII], if I can get that policy number?
[CUSTOMER][NEUTRAL] Um, this one is 02438450.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][NEUTRAL] Data service for the claim?
[CUSTOMER][NEUTRAL] It is um [PII].
[AGENT][NEUTRAL] Thank you for that information and what is your tax ID?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Looks like we've gotten, what's the CPT code you're calling in reference to?
[CUSTOMER][NEUTRAL] 93,010.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's for $34.
[AGENT][NEUTRAL] OK, one moment. I do see we did receive that claim.
[AGENT][NEUTRAL] Back in September, um, claim denied. Let me pull up the, um, EOB and see why I denied. One moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] OK, couldn't find it on the web portal. I don't know what's going on. I can't find anything on that web portal today.
[AGENT][NEUTRAL] You need the claim number.
[CUSTOMER][NEUTRAL] Well you can search on there without the claim number, but you have to use like the last four of the social mhm.
[AGENT][NEUTRAL] Oh, you can?
[AGENT][POSITIVE] Oh, I didn't know that. Wow.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Sometimes I can find it on there and sometimes I can't so.
[AGENT][NEGATIVE] That's embarrassing.
[AGENT][NEUTRAL] You got to tell me how it works.
[CUSTOMER][NEUTRAL] I'm like I'll just call and see.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so I'm showing that it denied because the maximum for that data service had already been.
[AGENT][NEUTRAL] Paid out.
[AGENT][NEUTRAL] Hold on a second.
[CUSTOMER][NEUTRAL] From the primary you think?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] 8:29. Let me double check something.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Well, you know what, the, the problem didn't even pay anything.
[AGENT][NEUTRAL] Oh, OK, I see what happened. um, the same tax ID sent a, uh.
[AGENT][NEUTRAL] It looks like it might have been a surgery code and we paid 500. Her maximum is $500 per day. So we received that claim first and then we received that one.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] That makes sense. I see where you paid the $500 on the different um claim.
[CUSTOMER][NEUTRAL] Alright, 500 per day.
[CUSTOMER][NEUTRAL] All right, so I'll just send that to the patient. What's the claim number on that one if you don't mind?
[AGENT][NEUTRAL] Um, the $34.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's 350-832-9.
[CUSTOMER][NEUTRAL] 350829
[AGENT][NEUTRAL] No, no, 350-832-9.
[CUSTOMER][NEUTRAL] 8329.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. Alright, and what, what day did did that deny on?
[AGENT][NEGATIVE] Um, it denied on.
[AGENT][NEGATIVE] We received it on the [PII]. It denied on the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then I have another patient. Are you able to do another one for me?
[AGENT][NEUTRAL] Sure, let me notate this account.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what's that policy number?
[CUSTOMER][NEUTRAL] Um, this one is 021 03372.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's uh [PII], 12468.
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] And the tax ID.
[CUSTOMER][NEUTRAL] This one is [PII].
[AGENT][NEUTRAL] So it looks like the claim was submitted twice the first time it denied because.
[AGENT][NEUTRAL] The office procedure is not covered and then the treatment at the visit was.
[AGENT][NEGATIVE] I think a penny and it wasn't covered under the.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The office freezer and not covered correct?
[AGENT][NEUTRAL] Yeah, the, uh, the co-pay associated with the physician's charges is not covered in under the plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For physician charge, OK, and what's the claim number on that one?
[AGENT][NEUTRAL] Claim number is.
[AGENT][NEUTRAL] 9 over the first one that we denied uh 352-1168.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright and your name was [PII], correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, do you, do y'all do uh reference numbers at all?
[AGENT][NEUTRAL] No, it's just my name and today's date and time. Was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] That's it I appreciate your help.
[AGENT][POSITIVE] Thank you for calling APL you have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.