AccountId: 011433970860
ContactId: bdb3a5c8-1c58-4163-bf19-b7dfb29b44f1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 460420 ms
Total Talk Time (AGENT): 125972 ms
Total Talk Time (CUSTOMER): 102176 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/bdb3a5c8-1c58-4163-bf19-b7dfb29b44f1_20250513T19:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, uh, my name is [PII] calling from provider's office to check on uh claim denial and my last name initial is [PII].
[AGENT][NEUTRAL] OK, [PII], I can help you with claim. Can I please get your callback number?
[CUSTOMER][NEUTRAL] Our callback number is [PII] with an extension of [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] The patient name is uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, and the patient's policy number, please?
[CUSTOMER][NEUTRAL] Uh, sure. It is 02292680.
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And then may I please have the data service and the charge amount?
[CUSTOMER][NEUTRAL] The data of service on the claim is uh [PII] and the charge amount is $302.57.
[AGENT][NEUTRAL] OK, and then what were the charges after the primary insurance paid?
[CUSTOMER][NEUTRAL] Uh, one second.
[CUSTOMER][NEUTRAL] I think it is 234.48.
[AGENT][NEUTRAL] OK. And may I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] It's uh Palmetto podiatric Group of Anderson.
[AGENT][NEUTRAL] And you said the claim was previously denied. May I have the claim number?
[CUSTOMER][NEUTRAL] Sure. The claim number is 3568042.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold on while I look up this claim and I'll be right back.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me on. I have the claim ready for you. Uh, the true claim number is 336-0603.
[AGENT][NEUTRAL] The claim number you gave me was denied because that was a duplicate claim. This is the original claim number and the claim was paid $68.09.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] With check number 1812016.
[CUSTOMER][NEUTRAL] Yeah, one second. Actually, uh,
[AGENT][NEUTRAL] And the check cleared the bank on.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We actually have the
[CUSTOMER][NEUTRAL] That claim number with me and we have actually received a payment for the 11,720. May I know why the 99203 code was denied?
[AGENT][NEUTRAL] Yes, ma'am. Office visits are not covered by the patient's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Of
[CUSTOMER][NEUTRAL] Is this under the patient's policy, patient's plan, right?
[AGENT][POSITIVE] Cool
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, can I have the patient's plan name?
[AGENT][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, one moment.
[CUSTOMER][NEUTRAL] [PII]. OK, got it. Um, can I have your
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Appeal's mailing address?
[AGENT][NEUTRAL] Yes, ma'am. It's um the same claims address that you sent the claim to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] An appeal has to be mailed within 180 days from the initial process date, and a letter will need to be sent why you want to appeal.
[CUSTOMER][NEUTRAL] OK. And how much you said the time is?
[AGENT][NEUTRAL] 180 days from the date the claim was initially processed.
[CUSTOMER][POSITIVE] Got it. Thank you so much. Can I have your name?
[AGENT][NEUTRAL] Yes ma'am, it's [PII]
[AGENT][NEUTRAL] And you can use my name and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For your reference number.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][POSITIVE] Got it. Thank you so much and thanks for assisting you. Have a great day, bye.
[AGENT][POSITIVE] You too, Ms. [PII]. Thank you for calling APL. You have a great day also.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye.