AccountId: 011433970860
ContactId: b1d9b3ce-f05e-4d44-80c7-5f5b52e5d47f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 611900 ms
Total Talk Time (AGENT): 123920 ms
Total Talk Time (CUSTOMER): 297361 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/b1d9b3ce-f05e-4d44-80c7-5f5b52e5d47f_20250218T21:50_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII], and I'm calling for Alexandria Springfield Emergency Physicians PC. I verified that you will be and this call is made for additional information about it and I. Please note the call will be monitored and recorded for quality and training purposes.
[AGENT][POSITIVE] Hey, I'm happy to help and check on a claim for you today. What's the uh policy number?
[CUSTOMER][POSITIVE] Thank you so much [PII]. The policy number, you mean the member ID?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] The member ID is 225067369.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you have a claim number for the date of service in question?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Let me check here.
[CUSTOMER][NEUTRAL] I don't have the claim number here.
[AGENT][NEUTRAL] OK, that number is not one of our policy numbers. Do you have the member's name or social? I can check that way.
[CUSTOMER][NEUTRAL] Yes, I have the social. Let me open this file.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Here we go, the social is [PII].
[CUSTOMER][NEUTRAL] And his name is [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What was the last name again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Nothing's coming up underneath his social. Is the last name spelled [PII] [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] And is the first name [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, let me try by the name.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is this for a medical or a dental claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's for a medical claim.
[AGENT][NEUTRAL] What is the patient's date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Let me check the date of birth is on.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm not finding any member policy under that name that matches that information.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Because we submitted the claim on [PII]. So you don't have the patient, is that right?
[AGENT][NEUTRAL] Not seeing anything and you never got any sort of claim number or anything like that?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm, let me check here. Let me double check here.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No problem [PII], no problem. Uh, may I know the caller reference number?
[AGENT][NEUTRAL] Call references my name with my last initial and then today's date. My name again is [PII] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I have another claim. Could you please help?
[AGENT][NEUTRAL] Is it a different member?
[CUSTOMER][NEUTRAL] Yes, for the different members.
[AGENT][NEUTRAL] OK, yeah, what's the policy number?
[CUSTOMER][NEUTRAL] Let me check here the policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah that's.
[CUSTOMER][NEUTRAL] The number is 01813087 M as in Mike L as in Lima 8.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and then patient's name and date of birth?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] The patient's name is [PII]. The date of birth is on [PII].
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] All right, thank you so much. And then what's the date of service?
[CUSTOMER][NEUTRAL] It's for [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right. And then the build amount?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The amount is $203.40.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And also.
[AGENT][NEUTRAL] OK, we don't have any claims on file for that billed amount of 20,340.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Do you have this uh $1,699.88?
[CUSTOMER][NEUTRAL] Do you have a dollar amount?
[AGENT][NEUTRAL] Let's see the.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] We have one claim on file date of service [PII]. The billed amount that it's showing is 59,740.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure ma'am, let me check here 597.
[CUSTOMER][NEUTRAL] Is that, is that under the claim number 3,559,180?
[AGENT][NEUTRAL] Let me double check and see what was some.
[AGENT][NEUTRAL] Correct, there was a benefit payment made for 20,340.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, received the payment, but I'm looking for the denied code 99214. Could you please check on that?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK bye bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's gonna be
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Did you need me to check on anything else for you today?
[CUSTOMER][NEUTRAL] [PII], are you there?
[CUSTOMER][NEUTRAL] I think that's all from my end. Could you please check on the denied code?
[AGENT][NEUTRAL] Tonight office visits aren't covered under the member's policy.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] Uh, I'm sorry. Your voice is breaking.
[AGENT][NEUTRAL] Office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEGATIVE] are not covered.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Thank you so much for that. Let me check one more time. And let me check the mailing address. Is it [PII], [PII]. Is that right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] That is perfect. And may I know the timely filing limit for the reconsideration?
[AGENT][NEUTRAL] No
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][POSITIVE] That is perfect, [PII]. I think that's all for me and [PII]. Thank you so much for your assistance. Have a great day. Bye for now. Take care.
[AGENT][NEUTRAL] You too bye bye.