AccountId: 011433970860
ContactId: c674928e-b31b-4f20-8322-b1046dbe247e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 654830 ms
Total Talk Time (AGENT): 145809 ms
Total Talk Time (CUSTOMER): 155763 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/c674928e-b31b-4f20-8322-b1046dbe247e_20250128T18:51_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII]. I'm calling from provider, sorry, I'm calling from provider's office. I'm calling to know the claim status.
[AGENT][NEUTRAL] OK. And you said your name was [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, [PII], I can help you with claim status. Can you um please give me your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Sure. [PII].
[CUSTOMER][NEUTRAL] And could you spell your name, please?
[AGENT][NEUTRAL] Yes, ma'am. It's [PII]. It's [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're very welcome. And then, what is the patient's name, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and patient's date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then what is the patient's policy number?
[CUSTOMER][NEUTRAL] It's 01887351, M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull in that policy real quick.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 23
[AGENT][NEUTRAL] OK, I've got the policy pulled up. What is the date of service of the claim?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I'm sorry, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what's the charge amount?
[CUSTOMER][NEUTRAL] $4,195 even.
[AGENT][NEUTRAL] Thank you and then what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] $75 co-payment was the only depending amount.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then, um, what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Pediatrics Medical Group of Florida.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look that claim up for you, [PII], and I'll be right back.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] You guys need to calm down.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you again. So I did find the claim. The claim number is 352-791-1. The $75 for the claim was denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK, this is so not covered under the patient's policy. So this is denied as non-covered as the patient's plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Can you will the patient.
[AGENT][NEUTRAL] Can I what?
[CUSTOMER][NEUTRAL] Can we bill the patient?
[AGENT][NEUTRAL] I can advise you on your company's policies on how to collect payment.
[CUSTOMER][NEUTRAL] OK. But I have the incorrect TOP with me. I don't find the non-covered reason here. It just shows um lacks information for adjudication. So is it possible for you to send the correct QOB?
[AGENT][POSITIVE] Yes ma'am, I most certainly can. What is your fax number?
[CUSTOMER][NEUTRAL] OK. So fax number is [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on hold while I send that fax to you and I'll be right back.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you. I've got that fax on its way.
[CUSTOMER][NEUTRAL] OK. Uh may I know when I will receive it?
[AGENT][NEUTRAL] Uh, in the next couple of minutes it's on its way now.
[CUSTOMER][POSITIVE] OK. Thank you so much for that information. So all the other CBDs are denied of primary paid more than secondary, right?
[AGENT][NEUTRAL] I'm sorry, what did you just, can you repeat that question real quick?
[CUSTOMER][NEUTRAL] Uh, sure. The CPT code 99214 was denied as office visits are not covered as the patient's plan, but all the other CPT codes are denied as covered by.
[CUSTOMER][NEUTRAL] Another payer, right, like primary already paid for them. That's the reason for the delay for other CPT codes, right?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] It just the I can only verify how the claim was processed. The claim was processed and denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I understand. May I know the time filing limit?
[AGENT][NEUTRAL] There is not one
[CUSTOMER][NEUTRAL] OK. May I know of the mailing address?
[AGENT][NEUTRAL] Yes, it's um [PII] and that is [PII].
[AGENT][NEUTRAL] That's in [PII].
[CUSTOMER][NEUTRAL] OK. May I know if there is any fax number to send out, please?
[AGENT][NEUTRAL] Yes, the fax number is [PII].
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's [PII]. Is that right?
[AGENT][NEUTRAL] No, no, [PII].
[CUSTOMER][NEUTRAL] 9423. OK. [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's all. Thank you so much for your help today.
[AGENT][POSITIVE] You're very welcome, [PII]. You have a great day and thank you for calling APL.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye-bye.