AccountId: 011433970860
ContactId: c75d0494-775f-4d6f-b2ba-a3825d5ba99e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 416640 ms
Total Talk Time (AGENT): 154106 ms
Total Talk Time (CUSTOMER): 152282 ms
Interruptions: 2
Overall Sentiment: AGENT=1.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/c75d0494-775f-4d6f-b2ba-a3825d5ba99e_20250604T19:14_UTC.wav
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[AGENT][POSITIVE] Good afternoon
[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. My name is [PII]. I'm calling from the provider's office. Health taxes provider network to check the claims. How are you doing today?
[AGENT][POSITIVE] I'm doing good today, [PII]. You're calling to check claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you. What is your callback number?
[CUSTOMER][NEUTRAL] Callback number is [PII]. Direct line with my extension.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What is the policy number?
[CUSTOMER][NEUTRAL] Policy number is
[CUSTOMER][NEUTRAL] 02013247.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Let me just repeat that to you. I have that as 020.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 13247.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] MA [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, and again, you're calling for claim status. I can assist you with that. What is the date of service and the total charge amount please.
[CUSTOMER][NEUTRAL] [PII] $506.61 is the total charge amount.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] [PII] and what's the total charge amount please again?
[CUSTOMER][NEUTRAL] $506.61.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, thank you very much. It shows that the claim was received. There was no payment on this claim. Let me get the.
[AGENT][NEUTRAL] That denial for you one moment please.
[AGENT][NEUTRAL] OK. For procedure code 99214.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEGATIVE] It denied as office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Procedure code 99395 that's not a covered benefit because it's not due.
[AGENT][NEUTRAL] You just take this on entry that shows a preventative or a wellness visit that's not covered.
[AGENT][NEUTRAL] And for procedure codes 93,000 and 36415, those both denied as the primary insurance provided full benefits.
[CUSTOMER][POSITIVE] OK. Thank you so much. When did you receive this claim?
[AGENT][POSITIVE] OK, let me get the information for you, [PII] one moment thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, the claim was received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] OK. Help me with the claim number as well.
[AGENT][NEUTRAL] Of course, it is 359-522-29.
[CUSTOMER][NEUTRAL] Sorry, 359.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] After that,
[AGENT][NEUTRAL] 52229.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] How me the call reference number. I do have one more data service for the same patient.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, I can help you with that, and we do not provide call reference numbers, [PII], however, you can use my name and today's date, and that last initial is [PII]. I'm ready for that next date of service and total charge amount.
[CUSTOMER][NEUTRAL] It's [PII] $506.61.
[AGENT][NEUTRAL] So it's two separate claims for the same amount?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, we only received one claim.
[AGENT][NEUTRAL] With the total charge amount of $506.61.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I can
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK. And uh I do have one more detail service. [PII] $160.44 is the total charge, ma'am.
[AGENT][NEUTRAL] OK, so the 2
[AGENT][NEUTRAL] And date of services again if you could repeat that for me.
[CUSTOMER][NEUTRAL] Sure. Why not?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] $160 and
[CUSTOMER][NEUTRAL] 44 cents.
[AGENT][NEUTRAL] OK, the claim was received and denied as office visits are not covered. One moment, let me get the information for you for this claim details. One moment. Thank you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, the claim was received on [PII] and processed and denied on [PII].
[CUSTOMER][NEUTRAL] OK me the claim number.
[AGENT][NEUTRAL] 359-523-4.
[CUSTOMER][NEUTRAL] It's 359-523-4. Did I got the correct one?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. And the denial is office visits are not covered under the patient plan and the particular CPT is not covered, right?
[AGENT][NEGATIVE] It denied as office visits were not covered by this policy.
[CUSTOMER][NEUTRAL] OK. And the particular CPT is not covered, nor the diagnosis, right?
[AGENT][NEUTRAL] Again, the service, the office visits is not covered by the policy.
[CUSTOMER][NEUTRAL] I'm asking, and, like, is, is there a CPT is not covered under the CPT diagnosis is not covered.
[AGENT][NEUTRAL] The diagnosis is covered.
[AGENT][NEUTRAL] The office visit is not covered under this policy.
[CUSTOMER][POSITIVE] OK. Thank you so much. So, uh, the call reference number will be your name and today's date. Then you've been extremely helpful. Appreciate your assistance. Have a wonderful day ahead. Bye-bye.
[AGENT][POSITIVE] Thank you for calling
[CUSTOMER][NEGATIVE] I don't like.
[AGENT][POSITIVE] Yeah, AP, have a great day.