AccountId: 011433970860
ContactId: c66d3343-8f90-413b-b961-38bfe8a13eca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 500119 ms
Total Talk Time (AGENT): 184879 ms
Total Talk Time (CUSTOMER): 154354 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/c66d3343-8f90-413b-b961-38bfe8a13eca_20250212T14:31_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. Last name initial is [PII], calling from the provider's office to check up on a claim. Could you help me with that?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the claim, [PII], and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, one claim.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII] direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, member's policy number is 19407.
[AGENT][NEUTRAL] Is that the group number or the policy number?
[CUSTOMER][NEUTRAL] Member's insured number.
[AGENT][NEUTRAL] What's the member's first and last name?
[CUSTOMER][NEUTRAL] Member's full name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, so I believe you said [PII]. OK, so this is her.
[AGENT][NEUTRAL] OK, so the correct policy number is 13,356,660.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the date of service for the claim that you like me to check on?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII]. The bill amount is.
[CUSTOMER][NEUTRAL] $2,575 even.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I locate that claim for you.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, it is Pediatrics Medical Group.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I shall receive the claim on [PII]?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah, OK, go ahead.
[AGENT][NEUTRAL] The claim number is 353.
[AGENT][NEUTRAL] 8508
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider, a total of $113.41.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, what's the procedure code that uh, that was paid? Is, uh, could you verify me with the procedure code?
[AGENT][NEUTRAL] Mhm. Procedure code 99215 was paid $50.
[AGENT][NEUTRAL] Procedure code 93325 was paid $18.75.
[CUSTOMER][NEUTRAL] 93325, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] $18.75.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 993,320 was paid $39.83.
[CUSTOMER][NEUTRAL] And then?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And 93005 was paid $4.83.
[CUSTOMER][NEUTRAL] Could you repeat the name?
[AGENT][NEUTRAL] 93005.
[AGENT][NEUTRAL] was paid $4.83.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh one moment.
[CUSTOMER][NEUTRAL] Uh, OK, for this, how much was the contractual adjustment amount?
[AGENT][NEUTRAL] Mhm. So this is their secondary policy. So you're trying to see why the balance wasn't paid?
[CUSTOMER][NEUTRAL] Uh-huh, uh, is there any patient responsibility?
[AGENT][NEUTRAL] Is that
[AGENT][NEUTRAL] We don't determine patient responsibility. We, we're not the major medical insurance company.
[CUSTOMER][NEUTRAL] OK, uh, so.
[CUSTOMER][NEUTRAL] All the procedure codes were allowed and paid correctly, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, you know patient responsibility on this claim, OK, and then, uh, when was this paid?
[CUSTOMER][NEUTRAL] I mean, what's the check number?
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So, it was paid on [PII].
[AGENT][NEUTRAL] The check number is 2017468.
[CUSTOMER][NEUTRAL] Is this this uh check number or an EFT?
[AGENT][NEUTRAL] That's the check number.
[CUSTOMER][NEUTRAL] OK, the check has been cleared.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes, it cleared on [PII].
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] One moment and uh could you verify me with the pay to address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for this.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Do you happen to find another claim, uh, for a bill amount for the same date of service for a bill amount of $2,042 even?
[AGENT][NEUTRAL] Yes, we received that claim on [PII].
[AGENT][NEUTRAL] The claim number is 353.
[AGENT][NEUTRAL] 972-3.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim, a total of $47.14.
[CUSTOMER][NEUTRAL] How much was it allowed?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] How much was that allowed?
[AGENT][NEUTRAL] That's what was billed. That was the total that was billed to us.
[CUSTOMER][NEUTRAL] No, I'm not, uh, the bill amount is $2,042. Uh, you guys paid 43.
[AGENT][NEUTRAL] That was the
[AGENT][NEUTRAL] So that's the total bill, again, we're the secondary company. So what was sent to us was $47.14 and that's what we paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, yeah, we're good with this one. And when was this, uh, what's the check number? Is it the same check number?
[AGENT][NEUTRAL] No, this is a different check. It was a single check.
[AGENT][NEUTRAL] Um, check number 2017958.
[CUSTOMER][NEUTRAL] OK, cleared on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] One moment, let me document that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Uh, since we don't have any explanation of benefits for both these claims, could you fax that over?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And that's attention [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that's [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so I will go ahead and send that over to you now. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Now, what's the call reference number for today's call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you, [PII]. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're very welcome. Thanks for calling APL. Bye bye.