AccountId: 011433970860
ContactId: db4dd91f-7ff4-48ef-99ae-36b3a073c4f3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 380500 ms
Total Talk Time (AGENT): 161846 ms
Total Talk Time (CUSTOMER): 138633 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/db4dd91f-7ff4-48ef-99ae-36b3a073c4f3_20250106T19:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] at Radilogy Consultants of Tulsa. I am checking on a claim.
[AGENT][POSITIVE] All right, [PII]. I'm happy to check a claim for you today. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] I have D as in dog 47,900.
[CUSTOMER][NEUTRAL] 087.
[CUSTOMER][NEUTRAL] I think that's 300.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] So we
[CUSTOMER][NEUTRAL] My eyeballs this morning, that's another story.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] We unfortunately can't pull the policy with that number. Do you have their name or social? I can try and find them that way.
[CUSTOMER][NEUTRAL] I do, I do, but hang on just a second. I actually do have a claim form or or an EOB. It's just.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Somebody didn't bother to give me give me page two let's see what's on here. How about 02132429? Does that work?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] 0213249, is that what you said?
[CUSTOMER][NEUTRAL] 429
[AGENT][NEUTRAL] 29, let me pull this.
[AGENT][POSITIVE] That sounds right.
[CUSTOMER][NEUTRAL] Uh, after I gave you that, I, I was gonna say I see a claim number now too.
[AGENT][NEUTRAL] All right. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], uh [PII].
[AGENT][NEUTRAL] Alright thanks yeah that's it, [PII] and then what's the claim that we're checking on?
[CUSTOMER][NEUTRAL] Um, it is a claim for data service 720 and 721.
[CUSTOMER][NEUTRAL] It was $148.25.
[CUSTOMER][NEUTRAL] Excuse me, sorry.
[AGENT][NEUTRAL] OK, and you said it's 14825.
[CUSTOMER][NEUTRAL] I do have a claim number if that will help you.
[AGENT][NEUTRAL] Yeah, what's the claim number that you have?
[CUSTOMER][NEUTRAL] 349-767-4
[AGENT][NEUTRAL] OK, yeah, I see that.
[AGENT][NEUTRAL] Alright, so yeah, it looks like there was a benefit payment sent for this claim in the amount of $200.
[CUSTOMER][NEUTRAL] There was. I'm showing 12,250.
[AGENT][NEUTRAL] No, it looks like it was $200 total. Um.
[AGENT][NEUTRAL] There was procedure code, well, there were two procedure codes of 70,450 on this claim. One paid 12,250, the other one paid 7750, it looks like.
[CUSTOMER][NEUTRAL] Is there a CPT code 71045?
[AGENT][NEGATIVE] Yes, and it looks like that was denied.
[CUSTOMER][NEUTRAL] What one was that denied for?
[CUSTOMER][NEGATIVE] That's the part I'm missing.
[AGENT][NEUTRAL] Let's see. OK.
[AGENT][NEUTRAL] Looks like, OK.
[CUSTOMER][NEUTRAL] Well, kind of, I also don't know about this extra 7750, but we'll come back to that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's showing um this medical test for the state of service is not covered under diagnostic test. Therefore, no benefit was payable for this portion of the claim.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So it's just not a covered service, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] right now
[CUSTOMER][NEUTRAL] The check I'm looking at is for only is only for $122.50 and we only build 170475 I'm sorry 0450.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So I'm a little bit confused on that.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Extra that you're saying I I don't have it so it's not like I could send it back to you anyway, but.
[AGENT][NEUTRAL] Interesting. OK, so uh this is alright, so you have 12,250 correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, and you have, I'm guessing the check number is 1870321?
[CUSTOMER][NEUTRAL] Yes,
[AGENT][NEUTRAL] OK, so there was another check cut for 7750, usually that's weird, cause usually it's a single check, but this was two checks.
[CUSTOMER][NEUTRAL] What was the date on that check?
[AGENT][NEUTRAL] So let me uh [PII], let's see.
[CUSTOMER][NEUTRAL] Same date
[AGENT][NEUTRAL] Issue date on this check was [PII].
[CUSTOMER][NEUTRAL] Sent to.
[AGENT][NEUTRAL] Sent to, oh.
[AGENT][NEUTRAL] That was
[AGENT][NEUTRAL] That's why you don't have that. That was paid to the insured.
[AGENT][NEUTRAL] So, yeah, that didn't go to you. That makes more sense now.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, well I'm gonna let you deal with that part.
[CUSTOMER][NEUTRAL] I don't know what that's about, but OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright, OK, well I just needed to know what the denial was on that one because whoever copied it did not copy me the back page, so I didn't know what that meant, so now I know where to go from there. Alright, thanks sir. Do you do call.
[AGENT][NEGATIVE] Gotcha.
[AGENT][POSITIVE] Sounds good, [PII].
[CUSTOMER][NEUTRAL] Do you do call reference numbers?
[AGENT][NEUTRAL] Um, yeah, absolutely. Call reference is my name with my last initial in today's date. So again, my name is [PII] spelled [PII] Last initial to my name is [PII].
[CUSTOMER][POSITIVE] Got you alright thank you have a good day.
[AGENT][POSITIVE] You're welcome. You too, bye bye.