AccountId: 011433970860
ContactId: d0966a4e-e4dc-4181-a47b-026c8fbfd97e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 470390 ms
Total Talk Time (AGENT): 144714 ms
Total Talk Time (CUSTOMER): 248595 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/d0966a4e-e4dc-4181-a47b-026c8fbfd97e_20250528T14:55_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] and last initial is [PII].
[CUSTOMER][NEUTRAL] And uh I need a claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you, [PII], and what is the policy number, please?
[CUSTOMER][NEUTRAL] Yeah, the policy number is going to be 018978883.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Uh, the callback number is going to be.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient name is.
[CUSTOMER][NEUTRAL] [PII], and last name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Date of service is going to be
[CUSTOMER][NEUTRAL] [PII] charge amount is $821.
[AGENT][NEUTRAL] OK, and what was the balance after primary process the claim?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] The balance total is 1 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 18645261.
[AGENT][NEUTRAL] $261 is the balance after primary.
[CUSTOMER][NEUTRAL] Yes. Uh, the left is deductible plus co-pay.
[AGENT][NEUTRAL] OK, give me one moment please.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK, and what is the name of the provider's office?
[CUSTOMER][NEUTRAL] Uh, McPerson Medical and diagnostic LLC.
[AGENT][NEUTRAL] OK, and while I'm looking at looking at 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 ELB. That site is at secured. Am as in [PII].
[AGENT][NEUTRAL] And I show the claim process is office visits are not covered for the 99215 code and for the rest, uh, they were processed as insured primary paid in full.
[CUSTOMER][NEUTRAL] OK. So you said uh office visit 99214 is not covered?
[AGENT][NEGATIVE] No 215 is not covered.
[CUSTOMER][NEUTRAL] No, sorry, 9921215.
[AGENT][NEUTRAL] Correct, and the other codes processed primary paid in full.
[CUSTOMER][NEUTRAL] OK. Why?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. So you, just one second, let me just check that.
[CUSTOMER][NEUTRAL] So one second, how much?
[CUSTOMER][NEUTRAL] OK. So, primary paid 99215 and left copay.
[CUSTOMER][NEUTRAL] And uh 76831.
[CUSTOMER][NEUTRAL] And do
[CUSTOMER][NEUTRAL] 58,340 left, $186 as deductible. And 99459 is also processing deductible.
[CUSTOMER][NEUTRAL] So you, uh, you are not uh processing uh deductible and copay?
[AGENT][NEUTRAL] Well, the co-pay for the office visit is not covered, but as far as this other code, the 58,340, I will send it back to the examiner for review, but the other two codes show zero on their deductible copay and co-insurance. But for this other code of 58,340, I will send the claim back for review.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so which one you will send like 48 58,340?
[CUSTOMER][NEUTRAL] Because this, this is, uh, this is the code is uh left as a deductible, uh, but you said uh you are not covering, uh, like office visit as a as a co-pay or just, or just
[AGENT][POSITIVE] Correct.
[AGENT][NEGATIVE] Correct. So that $75 co-pay is not gonna be covered.
[CUSTOMER][NEUTRAL] OK. So you basically, you are not covering co-pay amount. You just covered deductible and co-insurance amount, right?
[AGENT][NEUTRAL] For covered services, but this is for an office visit, which is not covered under the policy, uh, patient's policy, so that office visit is not going to be covered.
[AGENT][NEUTRAL] But for the other code.
[CUSTOMER][NEUTRAL] OK. And like under the missions plan?
[AGENT][NEUTRAL] Per the patient's policy with our company.
[CUSTOMER][NEUTRAL] OK, under the.
[CUSTOMER][NEUTRAL] OK. Under the patient policy, you basically, you are not covering uh the
[CUSTOMER][NEUTRAL] Office visit, whatever the left amount is, is deductible, copay or coinsurance. Is it correct? Under the office visit?
[AGENT][NEUTRAL] Correct, it's not going to be covered.
[CUSTOMER][NEUTRAL] OK, not covered. OK, now I understand. OK. So kindly, uh, uh, send back the claim for reprocessing for CBD code 85,358,340 because under this CBD code, insurance, uh, primary insurance process this CBD code in deductible with the amount of 186.
[AGENT][NEUTRAL] OK, like I said, I'm gonna send this claim back for a review. Is there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, no, thank you so much. Just, so, uh, can I get the, any ticket number for, uh, like, uh, the custization?
[AGENT][NEUTRAL] I'm sorry, can you get the what?
[CUSTOMER][NEUTRAL] Number, ticket number.
[CUSTOMER][NEUTRAL] Uh, like ticket number, like case number for reprocessing the claim.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] As a reference number.
[AGENT][NEUTRAL] You can use my name in today's status of reference.
[CUSTOMER][NEUTRAL] OK. Just one second. Let me just pull up my notes and I will note down your, note down the call reference number. OK. Tell me your name and reference number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, you a reference number is my name, which is [PII], last initial [PII] and today's date.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, 528-2025, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And by the way, in how how much time this claim will be finalized or process? How much time is required?
[AGENT][NEUTRAL] Uh, not sure. I would say give it 10 to 15 business days.
[CUSTOMER][NEUTRAL] 10 to 13 or 30.
[AGENT][NEUTRAL] 15 business days.
[CUSTOMER][NEUTRAL] 50, OK, 15 business days. All right.
[CUSTOMER][POSITIVE] OK. Thank you so much. OK, [PII], thank you so much for your time and information. Have a nice day.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You too, thanks for calling APL bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] All right.