AccountId: 011433970860
ContactId: fd72e51b-d4d8-4735-ab42-208770e33e0e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 693440 ms
Total Talk Time (AGENT): 155088 ms
Total Talk Time (CUSTOMER): 227259 ms
Interruptions: 7
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/fd72e51b-d4d8-4735-ab42-208770e33e0e_20250513T14:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling AP this is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Great, how may I help you?
[CUSTOMER][NEUTRAL] Just checking on claim status.
[AGENT][NEUTRAL] Hi.
[AGENT][NEUTRAL] OK, I can help you with claim status. May I please get your name and your callback number?
[CUSTOMER][NEUTRAL] I can help you. May I please get your name and your callback number?
[CUSTOMER][NEUTRAL] Callback number would be.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Extension would be [PII].
[AGENT][NEUTRAL] OK, thank you and what is your name sir?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], may I please get the patient's name, date of birth, and policy number?
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Yes. Patient's name would be [PII].
[CUSTOMER][NEUTRAL] Mayer, date of birth is going to be [PII]. And the policy ID number is going to be 016.
[CUSTOMER][NEUTRAL] 602
[CUSTOMER][NEUTRAL] 81
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you very much. Let me look that up.
[CUSTOMER][POSITIVE] OK, thank you very much.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, may I have the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Date of service is going to be [PII] and the bill amount would be $342.36.
[AGENT][NEUTRAL] Thank you. And may I have the amount after the primary insurance paid their part?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] So it is going to be $17.29.
[AGENT][NEUTRAL] And then what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Next step, foot and ankle centers INC.
[AGENT][NEUTRAL] OK [PII], I'm gonna put you on a quick hold while I look up this claim for us and I'll be right back sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Please take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 1720.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 7128.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you [PII] for holding for me. So looking on data service of [PII], I do not find a claim on file for that data service.
[CUSTOMER][NEUTRAL] [PII] I do not find a claim on file for that data service.
[CUSTOMER][NEUTRAL] So, do you want me to provide the claim number for this one?
[AGENT][NEUTRAL] Yes, what is that, please?
[CUSTOMER][NEUTRAL] Yes, what is that please? 352-643-3.
[AGENT][NEUTRAL] OK, let me look.
[AGENT][NEUTRAL] OK, I have a claim, but it's not for the provider that you gave me.
[AGENT][NEUTRAL] And it's for a different member.
[CUSTOMER][NEUTRAL] So that is the only uh claim number I do see just give me a moment let me check for it. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So for this one I do see we have received partial payments but there is no claim number that has been.
[CUSTOMER][NEUTRAL] Mentioned on the EOB which we have received from the payer. Just give me a moment here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Can you please check uh the claim number is 3416106.
[AGENT][NEUTRAL] 341-6106
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do show that that claim number has been paid.
[CUSTOMER][NEUTRAL] Claim number has been paid.
[AGENT][NEUTRAL] It was a different amount than what you gave me um in the beginning of the call but this claim was paid $32.71.
[CUSTOMER][NEUTRAL] It was a different amount than what you gave me um at the beginning of the call, but this claim was paid $32.71 check number 1834874.
[AGENT][NEUTRAL] We check number 1834874.
[CUSTOMER][NEUTRAL] Uh, could you please check and let me know the amount was taken back.
[AGENT][NEUTRAL] And let me check.
[AGENT][NEUTRAL] Yes, that that claim was paid $32.71 to next step foot and ankle, and the check cleared the bank on [PII].
[CUSTOMER][NEUTRAL] Yes, that that claim was paid $32.71 to next step foot in the ankle, but that cleared the bank.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] There was a procedure that was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] There was a procedure that was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Uh, that's like, uh, reason for that.
[CUSTOMER][NEUTRAL] Why the office visit is not covered?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Since we have received payment from the.
[CUSTOMER][NEUTRAL] Primary insurance for the same CPT code. Uh, is there any specific reason, uh,
[AGENT][NEUTRAL] Yes, um, under the patient's plan and policy, office visits are not covered.
[CUSTOMER][NEUTRAL] I'm not in the office.
[CUSTOMER][NEUTRAL] So on the patient's plan, the office visit will not be covered by the insurance.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And could you please let me know if there is any policy ID or the article number uh that you follow?
[AGENT][NEUTRAL] No sir, there isn't. It just goes by the patient policy certificate and office visits are not covered.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Got it. Just one moment.
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Anything else I can help you with today?
[CUSTOMER][NEUTRAL] One moment, sorry. I'm almost done. Just give me a moment here.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Yes sir. Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So, uh, I'm sorry, uh, thank you, thank you for being online. So, is there any particular, uh, guideline that you follow for this, uh,
[CUSTOMER][NEUTRAL] CPT code. Is there any particular, uh, specific guidelines that you follow?
[AGENT][NEUTRAL] No, again, it just goes by the patient policy certificate and under the patient's policy and plan office visits are not covered.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][POSITIVE] It's funny as
[CUSTOMER][NEUTRAL] Covered
[CUSTOMER][NEUTRAL] So for this one, can we submit the correctly?
[AGENT][NEUTRAL] You know
[AGENT][NEUTRAL] You can submit a corrected claim um there's not a timely filing limit for that you'll just need to send a letter why you want to correct it.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, and there is no specific timely filing limit for to the corrected claim, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] And yes, story. So I think I've done for the day. May I have your initial and your last name?
[AGENT][NEUTRAL] Yes, it's A
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] And the call reference number for this call is going to be?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][POSITIVE] Thank you, [PII]. That is all for today. Have a good day. Bye-bye.
[AGENT][POSITIVE] You have a wonderful day too, and thank you for calling APL. You take care, [PII].
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye bye.