AccountId: 011433970860
ContactId: e5f2d761-9841-4d00-ac23-fc4cdb50d990
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 540000 ms
Total Talk Time (AGENT): 185352 ms
Total Talk Time (CUSTOMER): 208172 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/e5f2d761-9841-4d00-ac23-fc4cdb50d990_20250204T22:01_UTC.wav
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[AGENT][NEUTRAL] Life, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. We're calling from Pro's office to checking on claims for the member.
[AGENT][NEUTRAL] May I have a callback number, please?
[CUSTOMER][NEUTRAL] Yeah, sure. I callback number is [PII].
[AGENT][NEUTRAL] May I have the policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. So the patient's policy number is 02544684.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. So the patient's name is [PII] and the date of birth is [PII].
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] May I have the date of service and total bill?
[CUSTOMER][NEUTRAL] Yeah, sure. The total, I mean, the data service falls on [PII] and the total charge amount is $1,478 even.
[AGENT][NEUTRAL] And you can also check claim status via our secured portal that is [PII]. I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, perfect. I get it.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Hold
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So for that claim it does show that we received it in twice.
[CUSTOMER][NEUTRAL] Mhm, could you please provide the updated results of the claim?
[AGENT][NEUTRAL] The updated claim is showing that it is a duplicate of the previous submitted claim.
[CUSTOMER][NEUTRAL] OK, so kindly provide the duplicate claim number.
[AGENT][NEUTRAL] The duplicate claim number is 354478, I'm sorry, 3544778.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it shows that the claim was denied on [PII].
[CUSTOMER][NEUTRAL] OK, and can you provide the original claim status.
[AGENT][NEUTRAL] It shows that the claim processed and made a payment.
[CUSTOMER][NEUTRAL] Mhm, may I know when the claim was processed?
[AGENT][NEUTRAL] It is showing that the claim was processed on [PII].
[CUSTOMER][NEUTRAL] May I have the claim number?
[AGENT][NEUTRAL] And that claim
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 9592. It shows that it processed and made a payment in the amount of $50. Once the $50 was paid, that is the maximum amount that will be paid out.
[CUSTOMER][NEUTRAL] Mhm. OK. So the paid amount is $50 for the claim, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, sure. And upon checking my end, so actually we build the 3 CPT codes on the claim and
[CUSTOMER][NEUTRAL] One CPT is billed for 99204 with the charge amount of $514. May I know the CPT code status?
[AGENT][NEUTRAL] As I stated, once that $50 was paid for the full amount of the claim, that means the per calendar day max had been met.
[CUSTOMER][NEUTRAL] Sorry, may I know the paid amount one more time? 150?
[AGENT][NEUTRAL] $50.50 for the whole claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And actually for the claim, so we build the 3 CPT codes. So for the whole claim, you're just providing that the allowed amount of the claim is $50 right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And may I know why the whole a lot claim will, I mean a lot amount is $50.
[AGENT][NEUTRAL] For the contract, this is an indemnity policy which is a limited benefit policy, so that is the maximum amount that could be paid out.
[CUSTOMER][NEUTRAL] Mhm. And just confirm that so the remaining balance, what happened was to provide a contractual adjustment or the patient's responsibility.
[AGENT][NEUTRAL] That's the provider's discretion.
[CUSTOMER][NEUTRAL] May I know the provider discount amount, may I know?
[AGENT][NEUTRAL] There is no discount amount. This is a limited benefit policy, so it's only based off of the amount per the policy.
[CUSTOMER][NEUTRAL] OK. So that's why I'm asking to you. So you mentioned that the patient have limited benefits policy. So that's why, so the remaining balance goes to patients responsibility or the provider contractual adjustment.
[AGENT][NEUTRAL] That is to providers discretion if they would like to submit that bill to the insured.
[CUSTOMER][NEUTRAL] Mhm. OK. And actually, so we build the three CPT codes, right? So 7681976805 and 99204. So could you please provide the line level information for the all of the CPT codes?
[CUSTOMER][NEUTRAL] Like split up of the CPT codes.
[AGENT][NEUTRAL] For 99204, it denied maximum benefit paid for that day.
[CUSTOMER][NEUTRAL] OK, 99204 was maximum benefits paid as per the day rate per day, right?
[AGENT][NEUTRAL] That is correct. And then for the procedure code 76805 is where the $50 was applied for that date of service for the procedure code 76819, it denied maximum per calendar day mix.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, perfect. Got it. And just confirm that, so.
[CUSTOMER][NEUTRAL] May I know the check information?
[AGENT][NEUTRAL] It is showing that the check number is 2016788.
[CUSTOMER][NEUTRAL] Mhm. May I know the single check or box check?
[AGENT][NEUTRAL] It is a single check and it shows that it cleared 12, 13-24.
[CUSTOMER][NEUTRAL] May I know when was the check was issued?
[AGENT][NEUTRAL] That will be the process date of [PII].
[CUSTOMER][NEUTRAL] Mhm and check was cashed on [PII], right?
[AGENT][POSITIVE] It was cleared, yes.
[CUSTOMER][NEUTRAL] Mhm. And just confirm that the pay to address is [PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, perfect. Actu[PII], as of now, so upon checking in my end, so we didn't receive any UB for the claim. So could you please send the copy of the UB which you mentioned that the maximum order amount me for the other two CPT code sites. So kindly send the copy of the UOB through our fax number. It will be for us.
[AGENT][NEUTRAL] May I have the fax number please?
[CUSTOMER][NEUTRAL] Yeah, sure. So our fax number is [PII] and you can use attention my name [PII].
[AGENT][POSITIVE] OK, I will get the request submitted over for you and is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And may I know how long it will take to receive on our end?
[AGENT][NEUTRAL] It can take up to 24 to 48 hours for the fax to be received.
[CUSTOMER][NEUTRAL] OK, sure, actually I didn't catch your name, so could you please spell your name for me?
[AGENT][NEUTRAL] It is spelled [PII] [PII] and today's date will be used as the call reference.
[CUSTOMER][NEUTRAL] Actually I didn't catch your name. Could you please repeat that?
[AGENT][NEUTRAL] You need me to spell it again or do you just need me to repeat what how it's pronounced?
[CUSTOMER][NEUTRAL] Could you please spell out your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Could you please spell out that?
[AGENT][NEUTRAL] OK, I just stated this will be my last time spelling it. That is spelled [PII]
[AGENT][NEUTRAL] Last initial of [PII] and today's date will be used as the call reference.
[CUSTOMER][POSITIVE] OK, got it. Thank you, take care. Thank you for assisting me. That's all for today. Have a wonderful day. Bye-bye.
[AGENT][POSITIVE] Thank you so much for calling American Public Life, [PII]. Have a great day.