AccountId: 011433970860
ContactId: 00053832-ab76-4931-91b8-b49ab9fccbcf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2255040 ms
Total Talk Time (AGENT): 734702 ms
Total Talk Time (CUSTOMER): 553980 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/00053832-ab76-4931-91b8-b49ab9fccbcf_20250204T17:47_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on a claim status.
[AGENT][NEUTRAL] OK, did you say your name was [PII]?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII] and it's spelled as [PII], and my initial is [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, [PII]. And you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Um, no, I do have, uh, 4 patients with me, and, uh, each patient has 2 data services.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] Yeah, so it's [PII].
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes. Yes, that's right.
[AGENT][NEUTRAL] OK, thank you. So before we start, [PII], you will use my name that I gave you along with today's date as your call reference number for all of them. Also, any information provided related to any claim that I checked for you will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy of our explanation of benefits, you will need to print that from our portal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] By going to secured. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To print those.
[CUSTOMER][NEUTRAL] Mhm I got it.
[AGENT][NEUTRAL] OK. So what is the first patient's policy number?
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] Yeah, um.
[CUSTOMER][NEUTRAL] OK ma'am and uh.
[CUSTOMER][NEUTRAL] OK. It's 01.
[CUSTOMER][NEUTRAL] 894931 M as Mike Lima 8.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any info OK. And what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Birth of Ornela and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] [PII], what is the first date of service and total bill amount?
[CUSTOMER][NEUTRAL] Yeah. So the first date of service is [PII] and the charge amount of $345 even. It's $345 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, there is no claim on file for this member for that data service. This policy was not active for that data service. This policy had termed on [PII]. So there's another policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You have an incorrect policy number for your dates of service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is your next day service for this patient also after [PII]?
[CUSTOMER][NEUTRAL] Um, I guess, yes. Could you please give me a minute? Let me check on it.
[AGENT][NEUTRAL] Cause I'll need to give you the new policy information.
[CUSTOMER][POSITIVE] Yeah, I got it.
[AGENT][NEUTRAL] And check to see if the claim was processed on that. Correct policy number.
[CUSTOMER][NEUTRAL] Um, so it's [PII].
[AGENT][NEUTRAL] OK, so then we'll have to come back to this policy number that you gave me. I'll do the first date of service first under the correct policy number and then we'll go back for your next date of service for this number. If it's from, you said it's from [PII].
[CUSTOMER][NEUTRAL] OK. OK. OK, I got it.
[CUSTOMER][NEUTRAL] Yeah, so that's another date of service for the same patient.
[AGENT][NEUTRAL] So the date of service that you gave me [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment and I'll check to see if that claim was received and processed.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is the name of the facility you're calling on behalf of?
[CUSTOMER][NEUTRAL] Um, I'm calling on behalf of Cleveland Clinic Foundation.
[AGENT][NEUTRAL] OK, so this claim was received on
[AGENT][NEUTRAL] 89 2024, processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3491445.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $192.43.
[AGENT][NEUTRAL] And that was paid on single.
[CUSTOMER][NEUTRAL] So the claim has been.
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] So the claim has been paid, right?
[AGENT][NEUTRAL] It has.
[CUSTOMER][NEUTRAL] OK. And uh may I know the allowed amount and the paid amount of this claim?
[AGENT][NEUTRAL] The benefit amount paid was $192.43 on this supplemental policy. This is not major medical insurance.
[CUSTOMER][NEUTRAL] OK, uh, is there any patient responsibility for this claim?
[AGENT][NEUTRAL] We do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] OK. Um, so is it a, uh, EFT payment or credit, uh, EFT check? OK.
[AGENT][NEUTRAL] This was a single check?
[AGENT][NEUTRAL] 186-7630.
[CUSTOMER][NEUTRAL] Single check.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] May I have the uh check mailing address?
[AGENT][POSITIVE] The check has cleared.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So is it uh the payment date cost for more than 45 days?
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] Yeah, the, that the payment did cost, uh, more than 45 days, I think, yeah, you have cost 45 days.
[AGENT][NEUTRAL] This check cleared on [PII].
[CUSTOMER][NEUTRAL] OK, I got it.
[CUSTOMER][NEUTRAL] Yeah, please give me a minute. Please give me a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So the check has been cleared, right?
[AGENT][NEUTRAL] Yes, sir, and I gave you the date of that.
[CUSTOMER][NEUTRAL] Yes, I got it. And I just need some, some more questions for this claim and we'll go to the next claim. And uh
[CUSTOMER][NEUTRAL] OK, just give me a minute. I'm searching for it.
[CUSTOMER][NEUTRAL] Yeah, so may I know the reference number for this call?
[AGENT][NEUTRAL] As I stated in the beginning of our call, [PII], you will use my name that I gave you and today's date as your call reference number for every claim that I check.
[CUSTOMER][NEUTRAL] OK. Uh, could you please spell your name for me?
[AGENT][NEUTRAL] And if you need a copy of the EOB, you will need to print that from our portal by going to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, could you please spell your name for me?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] First initial to last name S.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I got it. And today.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so, uh, can I go to the next date of the study?
[AGENT][NEUTRAL] OK, I'm gonna have to locate the correct policy for your next data service since it's from [PII]. Isn't that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What is the data service in [PII]? Data service and total bill amount I can locate the proper policy.
[CUSTOMER][NEUTRAL] Yeah, so the date of service is [PII] and the charge amount is $847 even. It's 847 even.
[AGENT][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So the policy number that you initially gave to me is the correct policy number for this particular data service?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me see if the claim was received.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this claim was also received. It was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And it was processed and denied.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3326074.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This claim was denied?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the reason for the denial is that we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK. So you need primary UB2 process, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. So I have a question. If you want to submit the primary UB, does this claim has past time filing cause I can see the data service is 2023, but if we submit the primary UB, does this claim get processed towards payment?
[AGENT][NEUTRAL] It will be reviewed. I cannot guarantee payment.
[AGENT][NEUTRAL] But yes, we need to, to further view this claim, we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] OK, I got it. So, uh, so what would be the timely filing limit if you want to submit the primary UV?
[AGENT][NEGATIVE] No timely filing for that?
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] OK. And uh what would be the mode of submission? Can we submit through mail or fax?
[AGENT][NEUTRAL] The primary EOB can be faxed to [PII].
[CUSTOMER][NEUTRAL] OK. So, can I have the mailing address for documentation purposes?
[AGENT][NEUTRAL] What mailing, yes, so what address do you have for claims?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What address do you have on file for claims?
[CUSTOMER][NEUTRAL] Uh, um, the address we do have on file is [PII].
[CUSTOMER][NEUTRAL] OK. [PII]. Is that the correct mailing address?
[AGENT][POSITIVE] That is correct. It is.
[CUSTOMER][POSITIVE] OK, I got it. OK, I got it.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Can you hold on for me for just a moment please, [PII]?
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][POSITIVE] Thank you, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey, honey.
[AGENT][NEUTRAL] I'm on the phone. I'll probably be on here for another hour at least with this this caller.
[AGENT][NEUTRAL] At Barner
[AGENT][NEUTRAL] They think her stomach, they think her stomach flipped and they're afraid that if the blood supply may have been cut off to too many organs for too long.
[AGENT][MIXED] Because she started acting kinda weird like she was before a little bit last night, but she gave her some of that pain medicine. She seemed fine. Then this morning, she's just seemed even more off color so she didn't even wait till they opened. She was just sitting there when they
[AGENT][NEUTRAL] Uh, when they opened at [PII].
[AGENT][NEUTRAL] And now, Doctor He is performing the surgery, but I don't know if she's gonna make it.
[AGENT][NEUTRAL] Mhm
[AGENT][NEGATIVE] OK, well, it's this hysterical and I'm fucking stuck talking to these people and I
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Yes, I can't, you know, I mean, she's, it's terrible. I mean, I'd be just sad, I mean.
[AGENT][NEUTRAL] But yeah, they, they don't know, they can't, they're not gonna know how bad it really is until
[AGENT][NEUTRAL] But she's in there now.
[AGENT][NEUTRAL] She's in surgery right now.
[AGENT][NEUTRAL] But it's not a lot of hope, and I told her don't give up. Just like I said in the thing, you know, God.
[AGENT][NEUTRAL] If it's his will, which I'm praying it is that he doesn't take ginger from her right now, I mean.
[AGENT][NEUTRAL] But it's, yeah, they think that her stomach has flipped.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Yup. And I, uh, [PII] is not going to work. She had taken her, dropped her, left her, but she had a doctor's appointment herself and so anyway, she had planned on going to work, but then when they said that no, he's got, he's got to do surgery, it cannot wait.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I was obviously not going to work. And she said, I told her that after, I mean, she was hysterical. I told her I said, you know, I'm working, but you, you know, if you wanna come over here so that you're not alone, cause I know [PII]'s at work, you can just come and be over here or I can, you know, at least be close to you. I don't know if she's gonna, I mean, she was just beside herself, so.
[AGENT][NEUTRAL] And I get it.
[AGENT][NEUTRAL] Anyway, so.
[AGENT][NEUTRAL] Anyway, but I've, I've got a foreigner on my line, of course, you know, he's gonna ask me the same thing 100 times. Do you think I'm in the mood for that?
[AGENT][NEGATIVE] I've been on the phone with his ass for about 20 minutes and I'm on 2 of what he says is 8 claims.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] I mean, it's, it's asinine. It's, it is, it's truly asinine.
[AGENT][NEUTRAL] I mean, I was short with him a second ago. I said I have already given you the answer to that question.
[AGENT][NEGATIVE] And I didn't give him the answer again. I mean, I'm, you know, my daughter, yeah, you know, and I can't even take 5 seconds to like
[AGENT][NEUTRAL] Anyway,
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alright, I will, honey. So let me, I, I'm sorry, I don't want to get back on the call with him, but I, I need to get back on this call.
[AGENT][POSITIVE] All right. All right, Baby, I love you too.
[AGENT][POSITIVE] [PII], I'm sorry about that. Thank you very much for holding for me. So did you need any additional information on this particular claim before I finish my portion of it so we can move to the next number?
[CUSTOMER][NEUTRAL] Um, no, we can go to the next number.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And what is your next member's policy number?
[CUSTOMER][NEUTRAL] The policy number is 1306681 M as Mike L as Lima 8.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Give me a minute. Let me verify.
[CUSTOMER][POSITIVE] OK, yeah, that's correct.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] I'm sorry, what was the first name one more time, please?
[CUSTOMER][NEUTRAL] Yeah, the first name is [PII] and the last name is [PII]. Yeah, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I could spell that for you if you want.
[AGENT][POSITIVE] Thank you. No, sir, that's OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the data service and total bill amount for her place?
[CUSTOMER][NEUTRAL] Yeah. The date of service is [PII] and the total charge amount is $660 even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said it's $660. Is that correct?
[CUSTOMER][POSITIVE] Yes. Yes, that's correct.
[AGENT][NEUTRAL] OK, so we do not have a claim on file for her for this state of service and total bill amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um.
[CUSTOMER][NEUTRAL] If the patient is currently active for the insurance?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And may I know the uh effective date and the payment date for this patient?
[AGENT][NEUTRAL] The effective date is [PII].
[CUSTOMER][NEUTRAL] OK, uh, and the same term date, please?
[AGENT][NEUTRAL] I, I, I said the policy was active.
[CUSTOMER][NEUTRAL] OK, so no, no time, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, I got it. And uh we can use this mailing address to resubmit the claim [PII].
[AGENT][NEUTRAL] [PII], yes, the same address. That's correct. And you must also send a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] OK, I got it. And what is the TFL to submit the claim, resubmit the claim?
[AGENT][NEGATIVE] As I stated before, there's no timely filing limit.
[CUSTOMER][NEUTRAL] OK. And if the file uh claim has been submitted, how much time it will take to get processed?
[AGENT][NEUTRAL] Approximately 7 business days, 7 to 10 business days.
[CUSTOMER][NEUTRAL] OK, I got it.
[CUSTOMER][NEUTRAL] And shall I go to the next data service for this patient?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the next date of service and total bill amount?
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Please give me my name.
[CUSTOMER][NEUTRAL] Yeah, the next date of service is [PII] and the charge amount is $1,037 even it's $1,0037. even?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said the data service is 627?
[CUSTOMER][NEUTRAL] Of 24.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This claim was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 348.
[AGENT][NEUTRAL] 1759.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $253.28.
[AGENT][NEUTRAL] That check did clear on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, may I know the check number?
[AGENT][NEUTRAL] 1863148.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, I got it. And yes.
[CUSTOMER][NEUTRAL] Uh, if you want to resubmit it again.
[CUSTOMER][NEUTRAL] Give a minute. Yes, so that's all the information I need for this claim. Uh, shall I go to the next claim then?
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] No, sir. I have to make my no, sir. I have to make my notes regarding each claim that I check for you first.
[CUSTOMER][NEUTRAL] Next patient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, OK. Just take your time.
[CUSTOMER][NEUTRAL] All the time I can go and I'll pull the patient.
[AGENT][NEUTRAL] OK, and your next patient's policy number, [PII]?
[CUSTOMER][NEUTRAL] Yeah. So, the next patient's policy number is 02377454. M as in Mike. L as Lima, 8.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII] and the charge amount is $481 even.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you did say it is for [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, there is no claim on file for this number for that data service.
[CUSTOMER][NEUTRAL] So, no claim on file, right, for this patient?
[AGENT][POSITIVE] That is correct. Yes, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it. Um, please give me a minute. Let me just check on some details.
[CUSTOMER][NEUTRAL] Um, if the patient is currently active with the insurance?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. So may I know the effective date of this patient?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, I got it. And may I know the payer ID for, uh, payer ID if you want to come?
[AGENT][NEUTRAL] The same as the other.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's when you will also have to send the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] I got it.
[CUSTOMER][NEUTRAL] OK, I got it. And yeah, uh, can I go with the next data service then?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah. The next date of service is [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Total bill amount.
[CUSTOMER][NEUTRAL] Yeah, the total charge amount is.
[CUSTOMER][NEUTRAL] $481. If not, no, no, 400, not 4.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's $305 even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this claim was received. It was received on [PII].
[AGENT][NEUTRAL] processed and denied on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 349-5313.
[AGENT][NEUTRAL] And the reason for the denial is office visits are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] By this policy.
[CUSTOMER][NEUTRAL] Of
[CUSTOMER][NEUTRAL] Or not covered.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Please, let me check whether we got payment for this claim actually.
[AGENT][NEGATIVE] It would maybe from her primary insurance but not from APL. This claim was denied by us.
[CUSTOMER][NEUTRAL] So, uh, what would be the solution for this if you want to get the payment for this claim?
[AGENT][NEUTRAL] If you want to file an appeal, you must have file file it within 180 days from the date of the decision that I gave you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it must be submitted in writing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To attention appeals department at the same address that you would mail a claim to, but it does say you need to put attention appeals department.
[CUSTOMER][NEUTRAL] OK. I got it.
[CUSTOMER][NEUTRAL] Yeah, so can I go to the next question then?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], and the next member's policy number?
[CUSTOMER][NEUTRAL] It's 02481583.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, patient's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you. The data service and total bill amount, the first one.
[CUSTOMER][NEGATIVE] Yeah, the date of service is [PII] and the charge amount is $514 even it's $514 even.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is that correct, [PII], 514?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, there is no claim on file.
[AGENT][NEUTRAL] For that data service and that bill amount.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, just give me a minute.
[AGENT][NEUTRAL] And this one is one that you would also have to send the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] OK. So, uh, if the patient is currently active in the insurance?
[AGENT][NEUTRAL] The patient has active insurance, but it's not this policy. This policy did term as a, um, excuse me, [PII]. She has a different policy number beginning this calendar year.
[AGENT][NEUTRAL] But your data service is under the correct policy number you gave me.
[CUSTOMER][NEUTRAL] OK, I got it. Um, so can I go to the next state of service then?
[AGENT][NEUTRAL] You can.
[CUSTOMER][NEUTRAL] And this one's the last.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the next date of service is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And the charge amount is $1,037 even. It's $1037 even.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK just one moment.
[AGENT][NEUTRAL] And again, I just want to confirm, you did say 5-12, 2024 for 1037. Is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, we also do not have that a claim on file for her for that data service and that bill amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So if the patient is currently active with the service, no.
[AGENT][NEUTRAL] Yes, that is correct. This policy was active from [PII] to its term date of [PII].
[CUSTOMER][NEUTRAL] OK, I got it. So, yeah, that's all the information I need, crazy.
[AGENT][POSITIVE] OK. Well, if that's all then, [PII] that I can help you with today, thank you again for calling APL and I hope that you have a very nice afternoon.
[CUSTOMER][POSITIVE] Yeah. Thank you and have a great day bye.
[AGENT][POSITIVE] Uh-huh. Thank you. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.