AccountId: 011433970860
ContactId: b4841452-ad20-4473-b651-28dbec5d1ca2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 243880 ms
Total Talk Time (AGENT): 85829 ms
Total Talk Time (CUSTOMER): 86542 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/b4841452-ad20-4473-b651-28dbec5d1ca2_20250505T17:18_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, um, I have a question about a claim, um, that we, I'm calling from a provider's office.
[AGENT][NEUTRAL] So you're calling to check the status of the claim. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] Sure, it's [PII] A, contact number is [PII].
[AGENT][NEUTRAL] [PII], what is the policy number of the member that you're calling to check the status of a claim for?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 01 2nd, let me just.
[CUSTOMER][NEUTRAL] 0199.
[CUSTOMER][NEUTRAL] 404
[CUSTOMER][NEUTRAL] 8 M as in Mike. L as in Lima 8.
[AGENT][NEUTRAL] Could you verify the patient's name and date of birth?
[AGENT][POSITIVE] And I'll be able to assist you.
[CUSTOMER][NEUTRAL] Oh, sure.
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] And what is the date of service that you're calling to check the status of a claim for?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] What is your procedure code?
[CUSTOMER][NEUTRAL] Um, I have 992139915227096 J 1010.
[CUSTOMER][NEUTRAL] And then 29966.
[AGENT][NEUTRAL] All of these procedure codes on the same claim?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] This claim was received [PII], processed [PII].
[AGENT][NEUTRAL] What is the name of that facility?
[CUSTOMER][NEUTRAL] Abs and spin and pain medicine.
[AGENT][NEUTRAL] I only have one procedure code of the 99213. What is your?
[AGENT][NEUTRAL] Billing amount.
[CUSTOMER][NEUTRAL] Yeah, um, so, so basically that's the only one that um should have been transferred over to the secondary.
[CUSTOMER][NEUTRAL] Uh, because the other ones they didn't have like uh like the primary page, the other codes already, um, the total bill amount was 1210.
[AGENT][NEUTRAL] Now what is the bill amount? So the claim that we received, it doesn't show what you're giving me. So what was the bill amount for that procedure code? Because let me look up the claim because I'm not, I'm only seeing the one procedure code. What was the total bill amount for that 99213 amount? What was the bill amount that you guys billed the page? Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] $50.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so it was 300.
[CUSTOMER][NEUTRAL] 300. Mhm.
[AGENT][NEGATIVE] Yes, so it was only one procedure code submitted for $300. There was no payment made on this claim, and the reason why is because office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Got it. Let me just write this down.
[AGENT][NEUTRAL] Would you like the claim number?
[CUSTOMER][NEUTRAL] OK, um, can I get your name and reference.
[CUSTOMER][NEUTRAL] Uh, can I get your name first?
[AGENT][NEUTRAL] My name is [PII], and unfortunately we don't provide a reference number so you can use my name at today's date as a reference. Is there anything else that I could assist you with today?
[CUSTOMER][NEUTRAL] And where is that
[CUSTOMER][NEUTRAL] What is the initial of your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right, thank you so much. No, that would be all thank you.
[AGENT][POSITIVE] Thanks for calling APL. Have a great day, [PII]. Goodbye.
[CUSTOMER][NEUTRAL] Mm