AccountId: 011433970860
ContactId: bc9f38bb-1ea6-47b4-a5a1-f36f66670f86
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 363399 ms
Total Talk Time (AGENT): 131833 ms
Total Talk Time (CUSTOMER): 151591 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/bc9f38bb-1ea6-47b4-a5a1-f36f66670f86_20250127T20:49_UTC.wav
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[AGENT][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] from the care team. How you doing today?
[AGENT][POSITIVE] I'm great how are you?
[CUSTOMER][NEUTRAL] Hey, I'm so wonderful, thank you for asking. Hey there, I have a provider on the line, um, he calls for claim status and he just has a question I can't answer. We're looking at policy number 1731964.
[AGENT][NEUTRAL] OK, and the provider's name?
[CUSTOMER][NEUTRAL] His name is [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and his callback number is [PII].
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] He called and verified [PII] part one and we're looking at claim number 34.
[CUSTOMER][NEUTRAL] 72745
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I did tell him about the benefits payable. He wants to know why, um, the claim only paid for 250 when patient responsibility was the 298 and change, but I don't have any denial codes on here, so I can't, uh, read anything off to him.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I'm pretty sure it's because we don't cover the administrative fees, but I just, I, it's not, you know what I mean, I'm just not trained, so I don't wanna say anything and get.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, no worries. I got it. So wait a minute. Yes, this is Metlink. OK. I had to make sure.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] Alright, and I'll I'll introduce you, Ms. [PII] when we join, OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] My pleasure.
[CUSTOMER][NEUTRAL] Hi [PII], are you still there with us?
[CUSTOMER][POSITIVE] Yes, I'm here. Hey, thank you for your patience. I have Miss [PII] on the line um and she's gonna be able to help you look at that claim a little further and figure out why it didn't cover that whole um patient responsibility, OK?
[CUSTOMER][POSITIVE] Sure. Thank you.
[CUSTOMER][POSITIVE] All right, thank you so much, I will be uh Eli. mhm.
[AGENT][POSITIVE] Good
[AGENT][NEUTRAL] Hello, this is [PII], and I'll be happy to assist you. Please be advised the verification of coverage does not guarantee the payment of a claim. And how are you today?
[CUSTOMER][POSITIVE] I'm doing great, thank you so much for asking. What about you?
[AGENT][POSITIVE] I am wonderful, thank you. So it looks like this claim was for Data Service 3202024 and it looks like it processed $250.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let's see what the EOB is showing. I'm just looking for the EOB.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] To see what the patient's responsibility is.
[AGENT][NEUTRAL] I do apologize. Our system is slow.
[CUSTOMER][POSITIVE] Not a problem, take your time.
[AGENT][NEUTRAL] So this is showing.
[AGENT][NEUTRAL] $250 as patience.
[AGENT][NEUTRAL] Deductible.
[AGENT][NEUTRAL] So the EOB.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, primary of your saying?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right, let me check. Give me a moment.
[CUSTOMER][NEUTRAL] Because as for the primary insurance, you be the overall deductible amount for 76641 is $398.07. The CPT code has split into two lines CPT of $250 and another one is for.
[CUSTOMER][NEUTRAL] Let me see $148.07. Can you see that in the primary UB as well?
[AGENT][NEUTRAL] And I do see that and it looks like it has a modifier of 50.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEGATIVE] And the second one does not.
[AGENT][NEUTRAL] OK, so what I'll do is I'll write this up and send it back over. Let me see how the original
[AGENT][NEUTRAL] Came in, one moment. Let me see how the original bill came in.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Because it looks like the only thing I am showing is
[AGENT][NEGATIVE] The 766-41 with the 50 modifier. It doesn't look like.
[AGENT][NEUTRAL] We received the provider bill for the other one.
[AGENT][NEUTRAL] Just wanted to verify.
[CUSTOMER][NEUTRAL] Because the, yes, because the primary insurance usually the USC insurance process this CPT code into two lines because of the modified 50.
[CUSTOMER][NEUTRAL] So the overall deductible amount must be $398.07 which is given at the end of the EOB of the primary insurance.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK, OK. So I'll write this up and send this over for reconsideration and just allow 24 to 48 hour turnaround and you can call back for an update on this one. I'll send it over.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Sure. Thank you so much.
[AGENT][POSITIVE] You are so welcome. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] No, that's all for today. Can, can you please spell your name for me?
[AGENT][NEUTRAL] Yes, it's [PII] Last initial is [PII]
[CUSTOMER][POSITIVE] Perfect, can I get the call reference please?
[AGENT][NEUTRAL] It will be my name along with today's date.
[CUSTOMER][POSITIVE] Perfect. Thank you so much, [PII], for providing information to me. Have a wonderful day. Bye-bye for now.
[AGENT][POSITIVE] You are so welcome and thank you for calling American Public Life us. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.