AccountId: 011433970860
ContactId: c9c147f3-0cee-4f70-8688-9a70a4fcadc2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 628119 ms
Total Talk Time (AGENT): 155425 ms
Total Talk Time (CUSTOMER): 94161 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/c9c147f3-0cee-4f70-8688-9a70a4fcadc2_20250313T15:15_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] with Integras Health. I was calling to check the status of a claim.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status and you say you're calling from, what's the name of the facility?
[CUSTOMER][NEUTRAL] Integris Health.
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And what was your name
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][POSITIVE] Perfect thank you.
[AGENT][POSITIVE] You're welcome. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Absolutely [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, 02061691.
[AGENT][NEUTRAL] Thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And may I have a date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Absolutely, um, [PII] bill amount $257.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. And you said [PII] for 257. Is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for you. And for future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] I think
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull this ELB one moment.
[AGENT][NEUTRAL] Can you verify the procedure code for me?
[CUSTOMER][NEUTRAL] Give me just one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It would be 99214 and 96127.
[AGENT][NEUTRAL] Yes, OK, thank you. Yes, it is this. All right, I'm waiting on the L. OK, one moment.
[CUSTOMER][POSITIVE] Oh, OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] All right, we process the claim on [PII].
[AGENT][NEUTRAL] And the claim was denied. The reason for this denial, um, for the 99214, we do not cover office visits, so that one was denied stating the office visits are not covered. With the code 96127, it looks like the outpatient benefits for the calendar year has been met.
[AGENT][NEGATIVE] The benefits was exhausting.
[AGENT][NEUTRAL] For the procedure.
[CUSTOMER][NEUTRAL] OK, said that for the procedure code 99214, you did not call or you guys do not excuse me, do not cover office visits and what was, what was the rest I'm so sorry.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] That's right.
[AGENT][NEUTRAL] The 96127, which is the procedure, we do cover procedures, but it looks like she already assessed her benefit when we received this claim.
[CUSTOMER][NEUTRAL] Just one second.
[CUSTOMER][NEUTRAL] And is there any way you could um fax me this EOB?
[AGENT][NEUTRAL] Uh, what is the fax number?
[CUSTOMER][NEUTRAL] Um, it is [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, [PII] to your attention.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] And also, so sorry, um, can you do can I change the attention possibly?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, I have my attention. do you like.
[CUSTOMER][NEUTRAL] OK, um, can we do P [PII].
[CUSTOMER][NEUTRAL] Claim.
[AGENT][NEUTRAL] OK, so P [PII]. Do you need me to put claim after that?
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][NEUTRAL] Plain, OK.
[AGENT][NEUTRAL] All right. And do you mind holding for me while I send this out to you right now?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Miss [PII]. Yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um, that is all.
[CUSTOMER][NEUTRAL] There's the reference number just your name and the date is the date?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, my name and today state. Mhm.
[CUSTOMER][POSITIVE] OK perfect thank you so much for all your help.
[AGENT][POSITIVE] You're welcome, Ms. [PII], and thank you for calling APL. You have a good day.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] Thank you. You're welcome.