AccountId: 011433970860
ContactId: ecdef0f0-bf54-492b-9746-03916dd3fa8a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 490899 ms
Total Talk Time (AGENT): 185267 ms
Total Talk Time (CUSTOMER): 130339 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/ecdef0f0-bf54-492b-9746-03916dd3fa8a_20250123T16:35_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider's office regarding a claim status.
[AGENT][NEUTRAL] OK, yeah, that'll help you with claim status today, [PII], and do you mind if I get a good call back number from you?
[CUSTOMER][NEUTRAL] Yeah, my callback number is [PII].
[AGENT][POSITIVE] Perfect, thank you. And what is the policy number we want to look at today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, policy number is 1116684.
[AGENT][POSITIVE] Alright perfect let me get that pulled up for you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right, [PII], and can you verify for me please your uh insured's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] And let me spell the last word for you. It's [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect, thank you so much. And what is the, either the claim number or the date of service we want to look at?
[CUSTOMER][NEUTRAL] Yeah, date of services.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the build them out?
[CUSTOMER][NEUTRAL] Bill amount is $764.
[AGENT][POSITIVE] Perfect thank you give me a moment to find that for you.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] All right. And what is the name of the facility on file for this claim?
[CUSTOMER][NEUTRAL] It's Park View Orthopedic Group.
[AGENT][POSITIVE] Perfect, I believe this is it. Hang tight.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Perfect, thank you so much for your patience. So this is the claim that I'm looking at. I see that we received your claim on [PII]. I show that your claim was processed the following day, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The.
[AGENT][NEUTRAL] I have your claim number listed as.
[AGENT][NEUTRAL] 3531977
[CUSTOMER][NEUTRAL] Well yeah
[AGENT][NEUTRAL] And I show that claim had benefits payable, um.
[AGENT][NEUTRAL] If $25 stating that with the payment um or with this payment, the maximum benefit amount for the services provided during the office visit is exhausted.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And I show your check number listed as 2014701.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So it was uh bulk check or single check?
[AGENT][NEUTRAL] It was a single check.
[AGENT][NEUTRAL] I show that that check was cut [PII] and then it was cashed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cash on
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] OK. So there is no patient responsibility?
[CUSTOMER][NEUTRAL] November?
[AGENT][NEUTRAL] Um, we're a supplemental insurance company. We do not determine responsibility.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, uh, can you, uh, so the check was issued on [PII]. Uh, can you please provide me the on which mailing address for it was issued?
[AGENT][NEUTRAL] Yeah, I went to [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] That was in [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So it was cash on [PII], correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, can you please provide me the, uh, payment you bill over my fax?
[AGENT][POSITIVE] Yes, I can absolutely fax you the EOB.
[AGENT][NEUTRAL] And let me pull it up for you.
[CUSTOMER][NEUTRAL] Oh sorry, I do have a payment UV.
[AGENT][NEUTRAL] Oh, you do? OK.
[CUSTOMER][NEUTRAL] Uh, but only 99213 is paid, uh, rest of three CPTs.
[CUSTOMER][NEUTRAL] It's not pay till yet.
[AGENT][NEUTRAL] Yeah, so it says if you look at that EOB that first code, it tells you that the maximum benefit for the services provided um was exhausted with that payment, and then you'll see that it lists on the rest of those codes that you've already met that maximum benefit.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] So it was met uh in terms of visit or in terms of amount?
[AGENT][NEGATIVE] So it's um a dollar amount is at $25 that exhausted the benefit.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, and it was uh met on [PII], correct?
[AGENT][NEUTRAL] Yes, with the, with the payment of that claim.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Just a second.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, what are the yearly benefits for this patient?
[AGENT][NEUTRAL] Yeah, you bet you I can give you the yearly benefits. I do wanna let you know that any benefit information I give you over the phone is always a verification of coverage and never a guarantee of payment. Um, it looks like the yearly outpatient benefit is $500 per calendar year.
[CUSTOMER][NEUTRAL] OK. Uh, can you please spell out your name?
[AGENT][NEUTRAL] Yes, it's [PII], first initial last name, [PII], and today's date. Oh, I'm sorry, I just started with the reference number. My name is [PII] and if you need a reference number, it's my name in today's date.
[CUSTOMER][NEUTRAL] Of course
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, can you please spell it again?
[AGENT][NEUTRAL] [PII] and then the first initial is [PII] for my last name.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And what will be the call reference number?
[AGENT][NEUTRAL] It would be my name in today's date.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. Thank you. Have a nice day.
[AGENT][POSITIVE] My pleasure [PII] you take care and thank you for calling APL.