AccountId: 011433970860
ContactId: ad3d4c3d-b7b6-4925-ae88-735a999c8d85
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1538839 ms
Total Talk Time (AGENT): 308138 ms
Total Talk Time (CUSTOMER): 390143 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/ad3d4c3d-b7b6-4925-ae88-735a999c8d85_20250312T14:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, this is [PII] calling from providers billing office. How are you doing today?
[AGENT][POSITIVE] I'm doing well. How are you doing today?
[CUSTOMER][NEUTRAL] Uh, I'm doing good, thanks for asking. Yes, before I proceed, these calls are being recorded for quality and training purposes. Is this OK for you to be recorded?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much for that. Yes, I'm looking for a claim status. Can you please help me out with that?
[AGENT][NEUTRAL] Yes, I can help you with claim status. Can you please give me your name one more time and your callback number?
[CUSTOMER][NEUTRAL] Yes, uh my name is [PII], and my callback number is [PII]. It's a direct line, no extension needed.
[AGENT][NEUTRAL] Thank you very much and then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes, um.
[CUSTOMER][NEUTRAL] Please give me a moment.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes, the policy number is 994,160.
[CUSTOMER][NEUTRAL] And the patient's name is [PII] Medicine with the date of birth [PII].
[AGENT][NEUTRAL] OK, and can you spell the patient's name for me, please?
[CUSTOMER][NEUTRAL] Yes, it's Bhat Medicine.
[CUSTOMER][NEUTRAL] Medicine
[CUSTOMER][NEUTRAL] With date of [PII].
[AGENT][NEUTRAL] OK. And um can you spell the the patient's name for me, please?
[CUSTOMER][NEUTRAL] Yes, uh, the member's first name is [PII]
[CUSTOMER][NEUTRAL] And the last name is [PII]
[AGENT][NEUTRAL] OK, let me see if I can find them real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK and then what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII] the bill amount $197 even.
[AGENT][NEUTRAL] $97.97?
[CUSTOMER][NEUTRAL] 197. It's 197.
[AGENT][NEUTRAL] OK, thank you. And then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Oh yes.
[CUSTOMER][NEUTRAL] It is $53.68.
[AGENT][NEUTRAL] Thank you. And then can you please give me the name of the facility?
[CUSTOMER][NEUTRAL] Yes, it's skin and Cancer Associates.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold for me while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me [PII]. I have the claim for you the claim number.
[AGENT][NEUTRAL] Is 355.
[AGENT][NEUTRAL] 0239.
[AGENT][NEUTRAL] And the claim was denied because the benefits were maxed for the calendar year.
[CUSTOMER][NEUTRAL] OK. Uh yes, please give me a moment.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] OK. Uh, can you please verify with the what it got exhausted, like, um, visit dollars or um unit. It got exhausted.
[AGENT][NEGATIVE] It's units. She gets 4 office visits a year and she used those up and no, and had no more office visits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, uh, upon checking my side, I do see only two office visits.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] May I know when it got uh
[AGENT][NEUTRAL] You're not
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah, that, um, you can't go by that because you're not the only provider that you go to.
[CUSTOMER][NEUTRAL] OK. Uh, is it the 5th time, uh, the patient got, uh, ENM service?
[AGENT][NEUTRAL] I'm sorry, what did you just say?
[CUSTOMER][NEUTRAL] Uh, there are 4 visits, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, may I know the dates for that?
[AGENT][NEUTRAL] No ma'am, I can't give you that information you're not the only provider that they see that's private.
[AGENT][NEUTRAL] But they used all 4 for the year.
[CUSTOMER][POSITIVE] OK, oh yes, please give me a moment. I'm very fine.
[CUSTOMER][POSITIVE] Um, yes, uh, thank you so much for patiently waiting.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh yes. Can I know uh when was the last visit happened?
[AGENT][NEUTRAL] No, ma'am. I can't get that information. That's private information.
[CUSTOMER][NEUTRAL] OK. Is it with uh our provider or a different provider?
[AGENT][NEUTRAL] It's it's different providers so I cannot give you any information.
[CUSTOMER][POSITIVE] Oh yes, thank you so much for that. Uh, is it a patient responsibility?
[AGENT][NEUTRAL] No ma'am, we can't give patient responsibility that's determined by the provider.
[CUSTOMER][NEUTRAL] we can
[CUSTOMER][POSITIVE] Oh yes, thank you so much for that. Um, yes, then, uh, can I have the call reference number please?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you so much for that. Uh, yes, I do have other claims. Can you please help me out with that claims also?
[AGENT][NEUTRAL] OK, you have how many more?
[CUSTOMER][NEUTRAL] 04
[AGENT][NEUTRAL] 4. OK. Is it for the same?
[AGENT][NEUTRAL] Um, insured.
[CUSTOMER][NEUTRAL] Uh, the other member.
[AGENT][NEUTRAL] OK. All right. And what is the next date of service?
[CUSTOMER][NEUTRAL] This is for the other member.
[AGENT][NEUTRAL] Another member?
[CUSTOMER][NEUTRAL] Like, uh, yes.
[AGENT][NEUTRAL] OK, what is the member's name, date of birth, and policy number, please?
[CUSTOMER][NEUTRAL] Yes, the policy number is 02444790 ML 8 and the number's name is [PII] with the date of birth [PII].
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[AGENT][NEUTRAL] OK, and then what is the data service for this member?
[CUSTOMER][NEUTRAL] Yes, so the the service is [PII].
[AGENT][NEUTRAL] And the charge amount please?
[CUSTOMER][NEUTRAL] Yes, it's $504 even.
[AGENT][NEUTRAL] And then after the primary paid their part, what was the balance?
[CUSTOMER][NEUTRAL] Yes, uh, please give me a moment. I should calculate that.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Oh yes, it's 128.02 cents.
[AGENT][NEUTRAL] OK, and then what is the name of the facility please?
[CUSTOMER][NEUTRAL] Yes, it's skin and cancer so it.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look up this claim for you and I will be right back.
[CUSTOMER][NEUTRAL] Yes, they can. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me [PII]. So looking on the data service of [PII], I do not find a claim on file for the amount that you have given.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yes, please give me a moment.
[CUSTOMER][NEUTRAL] Oh yes, can I please cross check with the mailing address that we have billed to?
[AGENT][NEUTRAL] Yes, um, it's [PII].
[AGENT][NEUTRAL] And that's [PII].
[AGENT][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][POSITIVE] Thank you so much for that. Uh, yes, can I have the payer ID?
[AGENT][NEUTRAL] Yes, that is [PII].
[CUSTOMER][POSITIVE] Thank you so much for that. Uh, yes, should I proceed with the other member?
[AGENT][NEUTRAL] Ma'am, what, what did you just say?
[CUSTOMER][NEUTRAL] Yes, um, should I proceed with the other member? Like I have completed the claim.
[AGENT][NEUTRAL] OK, so you've completed that one and you wanna move on to the next one. OK, uh, what is the next member's name?
[CUSTOMER][POSITIVE] Yes, exactly.
[CUSTOMER][NEUTRAL] Yes, so please give me a moment.
[CUSTOMER][NEUTRAL] Yes, uh, the members.
[CUSTOMER][NEUTRAL] First name is [PII] and the last name is, sorry, the first name is [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] It's [PII] and the last name is [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what's the member's date of birth and policy number?
[CUSTOMER][NEUTRAL] Yes, so the date of service, no, sorry, the date of birth is [PII].
[CUSTOMER][NEUTRAL] And the policy number is 0185063ML8.
[AGENT][NEUTRAL] OK, let me get that policy pulled up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said that that member's name uh number is [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, we're missing the digit.
[CUSTOMER][NEUTRAL] OK, please give me a moment.
[CUSTOMER][NEUTRAL] I do see it's 01850635 ML 8.
[AGENT][NEUTRAL] OK, let me try it again with that 5 on there now. I think it will pull in.
[AGENT][NEUTRAL] OK, I've got it pulled up and what is the date of service?
[CUSTOMER][NEUTRAL] Yes, the service is [PII].
[AGENT][NEUTRAL] And the charge amount please?
[CUSTOMER][NEUTRAL] Yes. So the bill amount is $747 even.
[AGENT][NEUTRAL] And then charges after the primary paid their part.
[CUSTOMER][POSITIVE] Mhm this skin right there.
[CUSTOMER][NEUTRAL] Oh yes, it's 193.13 cents.
[AGENT][NEUTRAL] OK, and then is the facility named the same?
[CUSTOMER][POSITIVE] Yes, exactly.
[AGENT][POSITIVE] OK, it's gonna quick hold. I'll be right back with you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you so much for holding for me Miss [PII]. Uh, looking on this data service of [PII], I do not find a claim on file for the amount that you have given me.
[CUSTOMER][NEUTRAL] Uh, yes, upon checking my side, uh there is a payment of 130. $60.
[AGENT][NEUTRAL] OK, do you have the claim number?
[CUSTOMER][NEUTRAL] For one CBT, uh, I don't have the claim number. That's the reason I'm on call.
[AGENT][NEUTRAL] OK, let me look.
[CUSTOMER][NEUTRAL] Uh, this is, this is for CPT 17004.
[AGENT][NEUTRAL] Alright, let me look real quick.
[AGENT][NEUTRAL] And you said how much was the payment?
[CUSTOMER][NEUTRAL] 130.62.
[AGENT][NEUTRAL] OK, I've got that payment, but that's not the amount that you gave me to look up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the claim number is 3552567.
[AGENT][NEUTRAL] And the claim was paid.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes, uh, is it 355-2567, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much. And the CPT 99213 got denied, right?
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] Yes, office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, it should be considered a special responsibility or uh.
[AGENT][NEUTRAL] Again, I can't give patient responsibility that's determined by the provider.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much for that. Uh yes.
[CUSTOMER][NEUTRAL] Should I proceed with the other member?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And what is the member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes, please give me a moment.
[CUSTOMER][NEUTRAL] Yes, uh, the member's name is [PII]. The date of birth is [PII].
[CUSTOMER][NEUTRAL] And the member's policy number is 01893582ML8.
[AGENT][NEUTRAL] OK, let me look up that one.
[AGENT][NEUTRAL] And let me repeat the number to you. 01893582 ML8.
[CUSTOMER][POSITIVE] Yes, exactly.
[AGENT][NEUTRAL] OK, that policy number is not pulling up the correct member.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, the insured name is uh [PII]. It's [PII]
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, that's it. Thank you so much for helping. I don't find the patient also.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][POSITIVE] Yes, that's it from my side. Thank you so much for helping. Have a nice day.
[AGENT][POSITIVE] You have a wonderful day too, Miss [PII] and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you so much bye bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.