AccountId: 011433970860
ContactId: eb138c5d-8a36-486b-91cb-0b09de60ad1e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 906830 ms
Total Talk Time (AGENT): 335692 ms
Total Talk Time (CUSTOMER): 282828 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/eb138c5d-8a36-486b-91cb-0b09de60ad1e_20250116T14:00_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. This is [PII] My insured last name is [PII]. I'm calling from the doctor's office to check the claim status.
[AGENT][POSITIVE] It would be my pleasure to assist you, [PII]. What is a good callback number?
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] it's a direct line.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] It's gonna be 02475461.
[AGENT][NEUTRAL] Thank you, [PII] and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] The first name is [PII].
[CUSTOMER][NEUTRAL] The last name is [PII].
[CUSTOMER][NEUTRAL] It's date of birth [PII]?
[AGENT][NEUTRAL] All right, thank you. And you were needing claim status for [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] It would be my pleasure to assist you with that claim status. Do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Uh, have the date of service. Uh, the date of service is going to be [PII].
[CUSTOMER][NEUTRAL] That charge amount $531 even 531.
[AGENT][NEUTRAL] Be
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you and what is the facility name, please?
[CUSTOMER][NEUTRAL] It's gonna be
[CUSTOMER][NEUTRAL] Premier physicians of North Texas PLLC.
[AGENT][POSITIVE] All right. Thank you, [PII].
[AGENT][NEUTRAL] OK, we did receive that claim.
[AGENT][NEUTRAL] On 65-2024.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And for the CPT 99204 that was denied as a non-covered service.
[AGENT][NEUTRAL] And that's for the patient's plan.
[CUSTOMER][NEUTRAL] Uh, after that,
[CUSTOMER][NEUTRAL] Mm, on [PII], the claim was submitted along with the primary EOB.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We did not receive that. This is the only claim we have requested the primary EOB for CPT 94,640. Do you know how that was sent?
[CUSTOMER][NEUTRAL] Yes, we submitted the primary.
[CUSTOMER][NEUTRAL] Uh, we submitted through one moment.
[CUSTOMER][NEUTRAL] You submitted through PELD.
[AGENT][NEUTRAL] Through
[CUSTOMER][NEUTRAL] I submitted the paper.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now that can be faxed directly to our claims department.
[CUSTOMER][NEUTRAL] There's no, uh, you don't receive any contact on December [PII], right?
[AGENT][NEUTRAL] We have not.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] And what is the time before before you to submit the
[AGENT][NEUTRAL] No only filings.
[CUSTOMER][NEUTRAL] The consideration.
[CUSTOMER][NEUTRAL] Can you repeat again?
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] There's no time refunding. OK, thank you so much for that.
[CUSTOMER][NEUTRAL] Uh, we need to submit the.
[CUSTOMER][NEUTRAL] Claim along with the primary primary for CPD of 99204 right.
[AGENT][NEUTRAL] Actually, you can just fax the EOB reference in the claim number. I can give you the claim number.
[CUSTOMER][NEUTRAL] OK, one moment please.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] And what is the fax number?
[AGENT][NEUTRAL] Fax number to our claims department is 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 94
[AGENT][NEUTRAL] 23
[CUSTOMER][NEUTRAL] You stated that [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And do you have a mailing address?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And what is the claim number?
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 4233.
[CUSTOMER][NEUTRAL] Instead of the 352-423-3, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you so much for that. One moment, and can you spell your first name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] In general, OK, thank you so much for that. Uh, I have one more data service with a different patient. Could you help with that?
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] Yes, sir. It would be my pleasure. Bear with me just one quick moment.
[AGENT][POSITIVE] I am ready for the next policy number whenever you are.
[CUSTOMER][NEUTRAL] Just one moment, I'm pulling that policy number.
[AGENT][POSITIVE] All right. Take your time.
[CUSTOMER][POSITIVE] Thank you so much for that.
[CUSTOMER][NEUTRAL] OK, the next policy number is going to be.
[CUSTOMER][NEUTRAL] 0247
[CUSTOMER][NEUTRAL] 5609.
[AGENT][NEUTRAL] Is there 247-5609?
[CUSTOMER][NEUTRAL] I'm repeating again 02.
[CUSTOMER][NEUTRAL] 475609
[AGENT][NEUTRAL] What is that patient's name?
[CUSTOMER][NEUTRAL] The first name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The last name is [PII]. Her date of birth.
[AGENT][NEUTRAL] OK, that is not
[AGENT][NEUTRAL] That is not pulling up that member. I apologize. I didn't mean to interrupt you. Can we do a name search?
[CUSTOMER][NEUTRAL] Can you repeat again?
[CUSTOMER][NEUTRAL] Yes, OK, well, the first time it spells like, OK, the last name it spells like [PII].
[AGENT][NEUTRAL] What, what's the last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And first name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Her date of birth?
[CUSTOMER][NEUTRAL] [PII] of.
[AGENT][NEUTRAL] Let me get her pulled up. I apo I apologize. I hate to keep interrupting you. I'm so sorry. I just need to get her pulled up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm still looking for her. Is she in [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, I did locate her.
[AGENT][NEUTRAL] And what is her date of birth? I apologize.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, it's going to be [PII].
[AGENT][NEUTRAL] All right, thank you. Can I give you the correct policy number?
[CUSTOMER][NEUTRAL] OK, uh, one moment, go ahead.
[AGENT][NEUTRAL] Her policy number is 024.
[AGENT][NEUTRAL] 75601.
[CUSTOMER][NEUTRAL] You stated that 024.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 75601
[AGENT][POSITIVE] Mhm. That's right.
[AGENT][POSITIVE] And I can help you with that claim status for [PII], and again, I apologize for interrupting you. I just, I couldn't do anything till I got it pulled up.
[CUSTOMER][NEUTRAL] Mhm I'm looking for the same claim status.
[AGENT][POSITIVE] So I appreciate that.
[AGENT][NEUTRAL] Alright, what's the data service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[CUSTOMER][NEUTRAL] The total charge amount $320 even $320.
[AGENT][NEUTRAL] Is it for the same facility?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right, [PII], we received that claim on [PII].
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEUTRAL] With a payment of $2.83.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] One moment, is the process on [PII], right?
[AGENT][POSITIVE] Yes, sir, that is correct.
[CUSTOMER][NEUTRAL] One moment and what is the other amount?
[AGENT][NEUTRAL] So the policy only pays toward the deductible co-pay or co-insurance for procedures or treatments in office.
[AGENT][NEUTRAL] So there's no allowed amount, it's just a benefit amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is it?
[CUSTOMER][NEUTRAL] 888.
[AGENT][NEUTRAL] That's right. We pay toward the deductible or co-insurance of the major medical. The 99214, the office visit is not covered for the patient's plan.
[CUSTOMER][NEUTRAL] Let
[CUSTOMER][NEUTRAL] CBD of.
[AGENT][NEUTRAL] 9921. That's right.
[CUSTOMER][NEUTRAL] 99214 right?
[CUSTOMER][NEUTRAL] Was not covered under the patient's plan, right?
[AGENT][POSITIVE] Yes, sir, that's correct.
[CUSTOMER][NEUTRAL] One moment, the only the paid on the 81003 is paid by the $22 right?
[AGENT][NEUTRAL] $2.83.
[CUSTOMER][NEUTRAL] One range.
[CUSTOMER][NEUTRAL] $2.08 right?
[AGENT][NEUTRAL] 2.83, yes, sir.
[CUSTOMER][NEUTRAL] 883.
[CUSTOMER][NEUTRAL] One moment please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what are the payment mode for the $2.
[AGENT][NEUTRAL] Single paper check.
[CUSTOMER][NEUTRAL] And what is the check number?
[AGENT][NEUTRAL] Check number 187.
[AGENT][NEUTRAL] 1302.
[CUSTOMER][NEUTRAL] 1871302, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] What do they should eat?
[AGENT][NEUTRAL] Issue date is [PII].
[CUSTOMER][POSITIVE] It was still a clear.
[AGENT][NEUTRAL] I apologize. Can you repeat that?
[CUSTOMER][POSITIVE] It was still outstanding?
[AGENT][NEUTRAL] No, sir. It cleared on [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Thank you so much for that. And what is the claim number?
[AGENT][NEUTRAL] Claim number 350.
[AGENT][NEUTRAL] 0135.
[CUSTOMER][NEUTRAL] You said that that 350-0135, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] One moment please.
[CUSTOMER][NEUTRAL] Uh, can you provide the status for the CPF 99214 was.
[CUSTOMER][NEUTRAL] The need for the it's not calling on the patient's plan, right?
[AGENT][NEUTRAL] Not covered. That's correct.
[CUSTOMER][NEUTRAL] Uh, what can I do for this claim?
[CUSTOMER][NEUTRAL] What is the patient's plan name?
[AGENT][NEUTRAL] It's a medlink gap policy. It's secondary to their primary insurance.
[CUSTOMER][NEUTRAL] Middling, right, can you spell out that?
[AGENT][NEUTRAL] M as in Mike. E as in Echo. D as in Delta. L as [PII].
[CUSTOMER][NEUTRAL] Midli after that?
[AGENT][NEUTRAL] Gap, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patients plan is middling gap HMO plan, right?
[AGENT][NEUTRAL] It's not an HMO it's just a secondary policy to their primary.
[CUSTOMER][NEUTRAL] The second report.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The secondary, the secondary instance is mid league camp, right?
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Mm for this one you need to be for the mid link gap, right?
[AGENT][NEUTRAL] Right, we are the meddling, yeah, we're the secondary policy.
[CUSTOMER][NEUTRAL] Uh, what can I do for this claim?
[AGENT][NEUTRAL] Uh, we pay the maximum benefit payable toward that deductible.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] We need to send we need to submit anything.
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] Separate for the deductible right for the remaining amounts.
[AGENT][NEUTRAL] So the 99214 is not covered. We did pay the 81003.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, in the amount that was listed for the deductible, therefore, we have processed and paid this claim.
[CUSTOMER][NEUTRAL] OK, what are the deductible amounts?
[AGENT][NEUTRAL] Well, the primary had that deductible of $2.83 toward that 81003. There's no deductible or co-pay on this plan.
[CUSTOMER][NEUTRAL] OK, how about the CPD of
[AGENT][NEUTRAL] We pay to the yeah, we pay to the deductible of the major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, for the CPD of 99214.
[AGENT][NEGATIVE] It's not covered.
[CUSTOMER][NEGATIVE] What can I do for the CBD? It's not right.
[AGENT][POSITIVE] It's, that's correct. It's simply a non-covered service.
[CUSTOMER][POSITIVE] Thank you so much for that, mm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And can you provide the call number?
[AGENT][NEUTRAL] Call reference number is my name in today's date, and I spell my name [PII].
[AGENT][POSITIVE] And [PII], it's been a pleasure to assist you with claim status today. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] Mhm thank you.
[CUSTOMER][POSITIVE] Nothing else. Thank you so much for that information. You have a wonderful day. Bye now.
[AGENT][POSITIVE] I hope you have a wonderful day as well and thank you for calling APL. Take care. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.