AccountId: 011433970860
ContactId: daaa8834-b4c2-453a-b465-9e1adb3b43ef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1222199 ms
Total Talk Time (AGENT): 291822 ms
Total Talk Time (CUSTOMER): 237089 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/daaa8834-b4c2-453a-b465-9e1adb3b43ef_20250616T12:20_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, this is [PII] calling from provider's office to check on a claim.
[AGENT][POSITIVE] Alright [PII] happy to check on the claim.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] I'm happy to check on a claim, [PII]. What is the policy number, please, for the patient?
[CUSTOMER][NEUTRAL] Yeah. It is 206-599-97.
[AGENT][NEUTRAL] Thank you. Do you have a good callback number please for documentation?
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][NEUTRAL] Thank you. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And just to reconfirm, the policy number was 206-599997?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you. What was the date of service?
[CUSTOMER][NEUTRAL] The data service is [PII] with the total charge amount of $511 even.
[AGENT][NEUTRAL] Thank you for your patience. So that claim was received on [PII]. Claim was denied [PII]. Office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] And who is responsible for that?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility. That's up to the facility or provider if they want to build the patient.
[CUSTOMER][NEUTRAL] Yeah, just give me a second.
[CUSTOMER][NEUTRAL] Uh, who is responsible for that?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, what was that again?
[CUSTOMER][NEUTRAL] Who is responsible for that?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility. That's up to the facility or the provider.
[CUSTOMER][NEUTRAL] Sorry, they are up to the?
[AGENT][NEUTRAL] I'm sorry, come again?
[CUSTOMER][NEUTRAL] Oh, what did you say that up to the?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility. It's up to the facility or the provider to bill the patient.
[CUSTOMER][NEUTRAL] Yes, sir, a second.
[CUSTOMER][NEUTRAL] Yeah, can you please uh help me with the call reference number?
[AGENT][NEUTRAL] Call reference is my name with today's date. My name is [PII], that's [PII]
[AGENT][NEUTRAL] Initial to my last name is [PII], then today's date.
[CUSTOMER][POSITIVE] Yup, surely move to the next one.
[AGENT][NEUTRAL] I need to notate this one if you have another one. Give me just one moment please.
[CUSTOMER][NEUTRAL] Yeah, for the same patient.
[AGENT][NEUTRAL] What's the data service?
[CUSTOMER][NEUTRAL] Yeah, it is 39 of 2024.
[CUSTOMER][NEUTRAL] With the total charge amount of $408 even.
[AGENT][NEUTRAL] [PII]. I'm not showing any claims on file.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No claims on file for [PII].
[CUSTOMER][NEUTRAL] For 408. I do have the claim number.
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] It is 351-868-87.
[AGENT][NEUTRAL] OK. So this claim was received [PII].
[AGENT][NEUTRAL] Denied and processed [PII].
[AGENT][NEUTRAL] Denial is office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] Who is just wanting for that?
[AGENT][NEUTRAL] Same as before, we're not able to advise on responsibility.
[CUSTOMER][NEUTRAL] OK, just a second, you actually want the next one?
[AGENT][NEUTRAL] Is it the same patient?
[CUSTOMER][NEUTRAL] Uh, it's different patient.
[AGENT][NEUTRAL] OK, then I need to notate this 11 moment.
[AGENT][NEUTRAL] OK, go ahead with the next member ID.
[CUSTOMER][NEUTRAL] Yeah. It is 02515492.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] What's the patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, yeah, let me help you with that. It is uh [PII]. Date of birth is uh [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] It is [PII] with the total charge amount of uh $1,445 even.
[AGENT][NEUTRAL] All right, just give me one moment, please.
[AGENT][NEUTRAL] Do you by chance have a different amount after the primary paid other than the 1,445?
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Yeah, the remaining balance is $175 even.
[AGENT][NEUTRAL] I'm not showing any claims on file for those amounts. Do you have a claim number?
[CUSTOMER][NEUTRAL] Yeah, I do have the claim number. It is um 3505258.
[AGENT][NEUTRAL] This claim shows the received date of [PII].
[AGENT][NEUTRAL] A process date [PII].
[AGENT][NEUTRAL] I'm showing on this claim there was a benefit payment sent in the amount of $264.31.
[AGENT][NEGATIVE] Uh, this is the maximum benefit payable for the date of service. It looks like part of it was applied towards their deductible of $100 and the office visit was denied. It's not covered under the policy.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Uh, you mean to say,
[CUSTOMER][NEUTRAL] Uh, the $125 is denied is uh non-covered, uh, because outpatient office visits are not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. $17.12 for the CPD code 17,110, uh, the deductibility to process $17.12 plus process towards deductible, right? Uh, it is for the same, uh.
[CUSTOMER][NEUTRAL] What is the denial reason for that?
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Code 17,000. That portion of it was applied towards the calendar year deductible.
[AGENT][NEUTRAL] 1711.
[CUSTOMER][NEUTRAL] Just give me a second.
[CUSTOMER][NEUTRAL] CPT code 99213 is denied as non-covered. OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK just a second. And
[CUSTOMER][NEUTRAL] The CPT code?
[CUSTOMER][NEUTRAL] 17,110 and uh
[CUSTOMER][NEUTRAL] 17,000.
[CUSTOMER][NEUTRAL] It was processed towards deductible.
[AGENT][NEUTRAL] No, 17,110 was paid out. There was a benefit paid in the amount of 26431. 17,000 was applied towards the deductible.
[CUSTOMER][NEUTRAL] OK. What about the remaining balance of $17.12?
[AGENT][NEUTRAL] As far as responsibility again, we're not able to advise on that.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Towards deductible.
[CUSTOMER][NEUTRAL] OK, what is the annual deductible amount?
[AGENT][NEUTRAL] $100.
[CUSTOMER][NEUTRAL] And how much was met?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] It looks like the patient's met the deductible for the year.
[CUSTOMER][NEUTRAL] How much was it? 100 was met?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] On which day it was met?
[AGENT][NEUTRAL] It doesn't show me the date.
[CUSTOMER][NEUTRAL] OK. Shall we move to the next one, same patient but different date of service.
[AGENT][NEUTRAL] What's the next date?
[CUSTOMER][NEUTRAL] It is [PII] with the total charge amount of $75 even.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim was received [PII]. Claim was denied [PII]. Office visits are not covered.
[CUSTOMER][NEUTRAL] OK, [PII], the next one.
[AGENT][NEUTRAL] Different patients.
[CUSTOMER][NEUTRAL] This different patient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Actually on the next one.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Yeah, it is um 02135059.
[AGENT][NEUTRAL] Name and date of birth.
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] As a service.
[CUSTOMER][NEUTRAL] [PII] with the total charge amount of $511 even.
[AGENT][NEUTRAL] 1012 of 24.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you have a claim number? I don't see anything on file for [PII].
[CUSTOMER][NEUTRAL] It is October [PII].
[AGENT][NEUTRAL] Claim was received [PII]. Claim was denied [PII].
[AGENT][NEUTRAL] Office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] You actually want the next one.
[AGENT][NEUTRAL] Same patient, different?
[CUSTOMER][NEUTRAL] Yeah, different patient.
[AGENT][NEUTRAL] I need to note this one if we're moving on, one second.
[AGENT][NEUTRAL] What's the next member's ID?
[CUSTOMER][POSITIVE] Oh yes, let me help you with that.
[CUSTOMER][NEUTRAL] The next number ID is
[CUSTOMER][NEUTRAL] 01947042.
[AGENT][NEUTRAL] Name and date of birth.
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Uh yes, let me help you with that. Data service is uh [PII] with the total charge amount of $358 even.
[AGENT][NEUTRAL] Did you say [PII]?
[CUSTOMER][NEUTRAL] No, it is [PII].
[AGENT][NEUTRAL] Clam received [PII].
[AGENT][NEUTRAL] Claim was denied [PII].
[AGENT][NEUTRAL] Denial was office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] OK. Shall we move on to the next one.
[AGENT][NEUTRAL] Different patients, same. One moment.
[CUSTOMER][NEUTRAL] It's a different patient.
[CUSTOMER][NEUTRAL] Yeah, different patient.
[AGENT][NEUTRAL] OK, member ID?
[CUSTOMER][NEUTRAL] Yes, it is 023.
[CUSTOMER][NEUTRAL] 20064.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. What is the date of service?
[CUSTOMER][NEUTRAL] Yup. Let me help you with that. Date of, uh, yeah, date of service is uh
[CUSTOMER][NEUTRAL] [PII] with the total charge amount of $358 even.
[AGENT][NEUTRAL] Claim was received on [PII].
[AGENT][NEUTRAL] Claim was denied and processed [PII].
[AGENT][NEUTRAL] Office visits are not covered under the member's policy.
[CUSTOMER][POSITIVE] Yeah, thank you so much. Uh have a nice day.
[AGENT][NEUTRAL] You too, [PII]. Bye-bye.