AccountId: 011433970860
ContactId: c60e902c-9860-4c41-bbfd-cfc5549c130e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 221660 ms
Total Talk Time (AGENT): 89454 ms
Total Talk Time (CUSTOMER): 83025 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/c60e902c-9860-4c41-bbfd-cfc5549c130e_20250307T17:52_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Uh, hi, my name is [PII] and I'm calling from provider office.
[AGENT][NEUTRAL] OK, and how may I assist you today, [PII]?
[CUSTOMER][NEUTRAL] Actually I'm looking for a claim information.
[AGENT][NEUTRAL] OK, I can verify claim status for you. And what is that policy number, please?
[CUSTOMER][NEUTRAL] It's 0245126862.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] For [PII] for $370 even.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And while I'm looking up claim information, just to let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you're calling from?
[CUSTOMER][NEUTRAL] Pro Health partners.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, I'm trying to claim process as uh doctor's inpatient visits are not covered per the policy.
[CUSTOMER][NEUTRAL] OK, so initially this claim was uh processed uh under the claim number ending with 536 and it was denied as non-covered service and that claim and that claim, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Was billed for 99232. However, as per the denial, we have Bill 99223 again.
[CUSTOMER][NEUTRAL] And that's the payable CPT code.
[AGENT][NEUTRAL] Well, part of the policy is not covered.
[AGENT][NEUTRAL] The policy doesn't cover doctors inpatient visits.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So according to you, any inpatient services bill will be the, will be non-covered, right?
[AGENT][NEUTRAL] Not for the physician visit. So if a doctors come and visit a patient in a hospital, that charge is not covered for the policy.
[CUSTOMER][NEUTRAL] OK. So, according to you, uh, per policy, uh,
[AGENT][NEUTRAL] According to the policy, not just me, according to the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so charges, uh, services, uh, bill in performing facility are uncovered, right?
[AGENT][NEUTRAL] Doctors inpatient visits are not covered per the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and the call reference number?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name in today's date. And is there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Your name
[AGENT][NEUTRAL] Uh, my name is [PII].