AccountId: 011433970860
ContactId: ed307056-5761-4ead-8797-e0d0b694f566
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1188439 ms
Total Talk Time (AGENT): 234248 ms
Total Talk Time (CUSTOMER): 284969 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/ed307056-5761-4ead-8797-e0d0b694f566_20250313T15:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi there, this is [PII].
[CUSTOMER][NEUTRAL] And I'm calling for a primary care PLLC. Please note this call will be monitored and recorded for quality and trains. I'm calling for payment status.
[AGENT][NEUTRAL] OK, I can help you with claims to out of [PII]. Can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] This callback number is [PII] and that's my extension.
[AGENT][NEUTRAL] OK, thank you. And then may I please get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, the patient's name is [PII] and the date of birth is [PII]. And the policy number is 253-6267.
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] that
[AGENT][NEUTRAL] OK, and then what is the date of service for [PII] for the claim?
[CUSTOMER][NEUTRAL] The service is [PII] and the charge amount is $150 even.
[AGENT][NEUTRAL] OK. And what is the name of the facility again, please?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The name of the facility, please?
[CUSTOMER][NEUTRAL] Yes, this is the name.
[CUSTOMER][NEUTRAL] Uh, Primary Care PLLC.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look up this claim for you and I'll be right back, [PII].
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Apatchy hm.
[AGENT][NEUTRAL] 353-282-6.
[AGENT][NEUTRAL] $75.
[AGENT][NEUTRAL] Check number 201519.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me. I have the status of the claim. The claim number is 353-282-6.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was paid $75 with check number 2015194.
[AGENT][NEUTRAL] After that payment it maxed out the benefit for the calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the check has cleared the bank.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it cleared the bank on [PII].
[CUSTOMER][NEUTRAL] And it it is your date?
[AGENT][NEUTRAL] The issue date was [PII].
[CUSTOMER][NEUTRAL] as soon as you need.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Yeah, allowed unpaid amount is $75 and there is no business, right?
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Uh, can you repeat the question?
[CUSTOMER][NEGATIVE] Alert and yeah, allowed and paid amount is $75 and there is no patient responsibility, right?
[AGENT][NEUTRAL] Uh, I can't give patient responsibility. That's determined by the provider.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I just pay through a single check or by check?
[AGENT][NEUTRAL] Single check
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much. Mhm. And could you please tell me the claim resident of the seat.
[AGENT][NEUTRAL] When the claim was received, let me look that up for you real quick.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] The claim was received [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] To you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Good, thank you so much for the information.
[CUSTOMER][POSITIVE] Actually, here we are outstanding procedure code 99.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah, here we have outstanding procedure code 99213. That car paid or denied.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Right after the $75 was paid, it maxed out the benefits for the calendar year.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] You said that this code is denied, right? 99213.
[AGENT][NEUTRAL] Let me pull up the EOB again.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 99213 is the CPT code that was paid.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] For the C code we have outstanding balance of $130.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, and after the $75 was paid it maxed out the benefits calendar year.
[AGENT][NEGATIVE] It exhausted the benefit.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] To the maximum benefit has been exhausted, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] So that code was delayed, right, and it doesn't pay. I only paid this code 83036 to the amount of $75 right?
[AGENT][NEUTRAL] No paid procedure code 213 of $75.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] And where would the remaining balance here we have uh for the CPT code we have $130 even remaining balances for data or patient discount.
[AGENT][NEUTRAL] That's determined by the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you so much, and could you please repeat the patient account number and pay to address.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yes, the account number is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you want to pay to address on the check, is that correct?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It was paid to Appalachian Primary Care.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And the zip code is [PII] and the check was cashed on [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yeah it was really really.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And it is uh issued on [PII], right?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much and uh could you please spell out your name for me? Have you spell your name?
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Yes ma'am, it's [PII]
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][NEUTRAL] Thank you so much, sorry. And uh here, I do have a patient account number as [PII]. Is it right?
[CUSTOMER][NEUTRAL] Let me check it for me.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh, we're showing that the patient account number for the facility is [PII].
[CUSTOMER][POSITIVE] Yeah, thank you so much.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Could you just start for me a copy of PDUB.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] Yes, can you please give me your fax number?
[CUSTOMER][NEUTRAL] Yes, the fax number is [PII] and attention to patient account number.
[AGENT][NEUTRAL] OK, it's gonna be a brief hold while I get that fax ready for you and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Come on on base.
[AGENT][NEUTRAL] Let me stop and try again.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] And now I'm on hold.
[AGENT][NEUTRAL] Come on.
[AGENT][NEUTRAL] There we go.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] [PII], I wanted to let you know I have not forgot about you. It's just take a moment for the fax to to pull up.
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I let you know I have not forgot about you. I know it's been a little bit it's fax is still trying to go through so it's gonna be a brief hold again.
[CUSTOMER][NEUTRAL] Yeah, that's OK.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on.
[AGENT][POSITIVE] Thank you [PII] for holding. I've got that fax on its way to you now.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, and how long will it take to receive the fax?
[AGENT][NEUTRAL] It just needs to go through the system through the lines. It should be there in the next 15 minutes.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] Yeah, uh, could you please spell your name for the story, right? [PII] Yeah, that's it.
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] You could be sent me the call reference to.
[CUSTOMER][NEUTRAL] Yeah that
[AGENT][NEUTRAL] Yes, you can use my name and today's date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much, sir. Thanks so much and yeah, I done it again and thanks for your kind assistance, sir. Have a great one. Bye-bye. Take care.
[AGENT][POSITIVE] You too you have a beautiful day and thank you for calling APL. There's nothing else I can help you with before we go?
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Uh, that's it, sir. Thank you so much for your patient. Bye.
[AGENT][NEUTRAL] Um bye bye.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Bye-bye, Ms. [PII].