AccountId: 011433970860
ContactId: d9bde845-34b1-44f3-bd11-a1ad192e382a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 670909 ms
Total Talk Time (AGENT): 226559 ms
Total Talk Time (CUSTOMER): 129263 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/2025/02/13/d9bde845-34b1-44f3-bd11-a1ad192e382a_20250213T15:40_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office, checking on the claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you, [PII]. And what is the policy number, please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The policy number is
[CUSTOMER][NEUTRAL] 01920754 Mary Lima 8.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] Date of service is [PII] and total charges are $542 even.
[AGENT][NEUTRAL] OK. And do you have the balance after Primary is processed the claim?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and that amount is?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 40 $40 copy.
[AGENT][NEUTRAL] OK, I don't show this claim has been received. Can you verify the mailing address the claim was submitted to?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII] and the zip code is [PII].
[AGENT][NEUTRAL] Uh, that address has changed. Uh, when you're ready I can give you the current and uh mailing address and or fax number.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let me know when you're ready.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Can you put on
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So for this patient, no claim on file?
[AGENT][NEUTRAL] Correct. We have not received the claim. The mailing address you have, uh, you verified is no longer active, so that's the mailing address for claims.
[CUSTOMER][NEUTRAL] OK, can you provide me the time limit?
[AGENT][NEUTRAL] There's no time limit.
[CUSTOMER][NEUTRAL] OK. Can you provide me the effective dates of the policy?
[AGENT][NEUTRAL] Effective date [PII] and the policy is active.
[CUSTOMER][POSITIVE] Thank you. I have one more claim. Can you pull information for that?
[AGENT][NEUTRAL] Is it for the same patient or different patient?
[CUSTOMER][NEUTRAL] Different patient?
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He.
[AGENT][NEUTRAL] OK, and what is the next policy number, please?
[CUSTOMER][NEUTRAL] 024
[CUSTOMER][NEUTRAL] 62,630.
[AGENT][NEUTRAL] And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Patient's name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] OK, and the date of service amount of the charge?
[CUSTOMER][NEUTRAL] Date of service is [PII] and total charges of $3480 even 3480.
[AGENT][NEUTRAL] And the amount after primary?
[CUSTOMER][NEUTRAL] $477.40.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] One moment. And do you have the, uh, what was the balance after primary?
[CUSTOMER][NEUTRAL] Yes. For $77.40.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And the name of the provider's office?
[AGENT][NEUTRAL] And the name of the provider's office?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Yeah, the name of the office is Galloway Anesthesia Associates.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] You said the total charge amount was $3480. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what's the physician's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I think we received a claim for that data service from that provider, but it was a different amount than what you gave.
[AGENT][NEUTRAL] And that claim processes benefits of max for the data service.
[CUSTOMER][NEUTRAL] OK, with different amount.
[AGENT][NEUTRAL] Mhm. Verify the procedure code with the modifier, please.
[CUSTOMER][NEUTRAL] Procedure code is 00813 and the modifier sir VZ and P2.
[AGENT][NEUTRAL] Yeah, uh, it's, we received a claim for that, like I said, for that day for that provider, for that procedure code, but it's showing a different amount.
[AGENT][NEUTRAL] And it was processed as benefits of max for the data service.
[CUSTOMER][NEUTRAL] OK. May I know the maximum benefits for the patient?
[AGENT][POSITIVE] For outpatient, they had a benefit max of, give me a moment.
[AGENT][NEUTRAL] Up to $350 per calendar day and they've already met that max for that date.
[CUSTOMER][NEUTRAL] $300 per day.
[AGENT][NEUTRAL] $350 per calendar day and they've already met that max for the day.
[CUSTOMER][NEUTRAL] Yeah, but for the date of service we have built only one claim.
[AGENT][NEUTRAL] It's for any uh claims for that data service. They've already met the max per the data service. It's a per day benefit, so we can come in for surgery or for facility or diagnostic or any other provider, but if it's on that same date and I've already met that max for that date of service.
[CUSTOMER][NEUTRAL] OK. May I know when was the claim received?
[AGENT][NEUTRAL] Uh, the claim was received on
[AGENT][NEUTRAL] [PII], process on [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The claim was received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] Yeah, but we have submitted the claim on [PII].
[AGENT][NEUTRAL] I don't show any claims being received on that date or around that date. We received this claim.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] So, you are seeing for the total charges of $1720 even?
[AGENT][NEUTRAL] I'm sorry because you gave a totally different amount. You gave an amount of $30,480. Like I said, we received a claim for that data service for that provider, for that procedure code with those modifiers, but it was for a different amount.
[AGENT][NEUTRAL] And it processed as benefits max for the data service. The amount was $3,915.
[CUSTOMER][NEUTRAL] OK, can you tell me the amount?
[CUSTOMER][NEUTRAL] OK, can I have the claim number?
[AGENT][NEUTRAL] 334-806-6
[CUSTOMER][NEUTRAL] Thank you. Can I have the call reference number?
[AGENT][NEUTRAL] We don't give reference numbers. If you like, you may use my name in today's date, and [PII], is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No. Thank you for your assistance. Have a great day.
[AGENT][POSITIVE] Alright, you're welcome. Thank you for calling APL. Have a great day. Bye.