AccountId: 011433970860
ContactId: ec4223eb-4378-48e8-bc61-338fecd90f3d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 411619 ms
Total Talk Time (AGENT): 100838 ms
Total Talk Time (CUSTOMER): 84347 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/ec4223eb-4378-48e8-bc61-338fecd90f3d_20250512T14:38_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], and I'm calling for a provider to check on additional information about a claim that has been delayed. Please note that this call will be monitored and recorded for quality and training purposes. How are you today?
[AGENT][NEUTRAL] I'm fine, [PII], and I can verify claim status for you. And what is that policy number, please?
[CUSTOMER][NEUTRAL] It's 02158668 M as in Mike, L as in Lima 8.
[AGENT][POSITIVE] OK, thank you so much, give me one moment please.
[AGENT][NEUTRAL] And do you have a, sure, it's K as in Kilo, E as in Echo, K as in Kilo, E as in Echo, last initial [PII]. And [PII], uh, do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Can you please spell out your name?
[CUSTOMER][NEUTRAL] Yes, it's [PII] and it's direct line?
[AGENT][NEUTRAL] Thank you and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] So the patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you say you're calling for claim status, correct?
[CUSTOMER][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Uh, what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And the amount of the charge?
[CUSTOMER][NEUTRAL] So the total amount is, let me check and tell you one second.
[CUSTOMER][NEUTRAL] It's $150 and even.
[AGENT][NEUTRAL] And the balance after primary?
[CUSTOMER][NEUTRAL] So the balance amount is $53.30.
[AGENT][NEUTRAL] OK, and you're calling from?
[CUSTOMER][NEUTRAL] I'm calling for behalf of providers.
[AGENT][NEUTRAL] No, what is the name of the provider's office please?
[CUSTOMER][NEUTRAL] It's foot, ankle, and leg specialist of South Florida INC.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh one moment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK one moment please.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Sorry, I'm trying to pull up information give me one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] It's gonna be a moment.
[AGENT][NEGATIVE] Sorry, my system is running a little slow.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] To
[AGENT][NEUTRAL] OK, I'm showing on this claim, we paid 2586.
[AGENT][NEUTRAL] And that was to to code 73,610?
[AGENT][NEUTRAL] The other code of 99212 processes office visits are not covered as per the policy.
[CUSTOMER][NEUTRAL] So you're setting it's a non-covered service and the office visits are not covered under the member's plan, am I right?
[AGENT][NEUTRAL] Correct, offices are not covered, but we paid 5886 towards the other code.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So, can I get the member's plan name?
[AGENT][NEUTRAL] It's called [PII]
[CUSTOMER][NEUTRAL] So just for confirmation for the CPT code 99212 with the modified25 you're stating it's an office visit and office visits are not covered by this member's plan and the member's plan name is [PII]. Am I right?
[AGENT][POSITIVE] Uh, that is correct. Yes, sir.
[CUSTOMER][NEUTRAL] OK, thank you for that. Can I get the call reference number for this claim?
[AGENT][NEUTRAL] Uh, if you like, you may use my name in today's date and my name is spelled [PII].
[CUSTOMER][POSITIVE] OK, thank you for that and thanks for helping me today. Have a great day. Bye-bye.
[AGENT][POSITIVE] Oh, you're welcome. Thank you for calling APL. Have a great day, [PII].