AccountId: 011433970860
ContactId: 028cb895-76a0-4b33-a857-259cdca00b2c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 935710 ms
Total Talk Time (AGENT): 244543 ms
Total Talk Time (CUSTOMER): 427679 ms
Interruptions: 7
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/028cb895-76a0-4b33-a857-259cdca00b2c_20250428T12:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for the provider to check on the claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. May I know how can I help you with the patients?
[AGENT][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] Mhm. I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy.
[CUSTOMER][NEUTRAL] Yeah, the policy number is 60801.
[AGENT][NEUTRAL] OK, that's our tax ID number. Do you have a copy of the card?
[CUSTOMER][NEUTRAL] Yeah, I do have the copy of the card.
[AGENT][NEUTRAL] OK, the numbers should is probably gonna start with a 0.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, is it it's not patient, give me a minute.
[AGENT][NEUTRAL] Either one of them would work.
[CUSTOMER][NEUTRAL] OK, 0, is it [PII] [PII] [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you. And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]. No extension to direct line.
[AGENT][NEUTRAL] OK, thank you. Give me 1 2nd.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi my name is.
[CUSTOMER][POSITIVE] OK I appreciate that.
[CUSTOMER][POSITIVE] Alright that's what I need.
[AGENT][NEUTRAL] Almost there, one moment.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII] and the date of birth will be [PII].
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, thank you for that information and you said that you're checking a claim status. I can help you with that information. What is the policy number, I mean the date of service and the total charge?
[CUSTOMER][NEUTRAL] The date of service is [PII] and total charges will be
[CUSTOMER][NEUTRAL] Give me a minute. Total charges is $2030 even.
[AGENT][NEUTRAL] OK, and you said the date of service is [PII]?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what are the procedure codes on the claim?
[CUSTOMER][NEUTRAL] Procedure codes on the claim, it's just a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 90 93015.
[CUSTOMER][NEUTRAL] 78452
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] 10.
[AGENT][NEUTRAL] So this claim was received [PII], processed on [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Uh, actually, [PII], we have submitted the claim. Uh, we, we have submitted.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Yeah, yeah, let me rephrase that. The received date, the received date was [PII], and the process date is [PII]. Did you receive the EOB already and had questions?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, yeah, we have received the EOB and could you please tell me uh the received it and the processed date once again?
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII] is the received date. [PII], I'm sorry [PII] is the process date. And what was your question?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh yeah, then what's the claim status right now?
[AGENT][NEUTRAL] OK, did you receive the explanation of benefits?
[CUSTOMER][NEUTRAL] Uh, yeah, we have received.
[AGENT][NEUTRAL] OK, on the back of the explanation, it gives you the remark code. It says that treatment.
[AGENT][NEUTRAL] In an office setting is not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. She turned to the back of the ELD.
[CUSTOMER][NEUTRAL] Under the member's plan?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] It's not cover under the member's plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, could you please tell me the reason once again because I want to make a note of it. Could you please state it once again?
[AGENT][NEUTRAL] Treatment in the office is not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Give me a minute. mm.
[CUSTOMER][NEUTRAL] OK, as per you which CPT is, uh, CPT code is not covered under the patient's policy.
[AGENT][NEUTRAL] Just treatment, any treatment in the office. Those are treatment codes, so treatment in the office is not covered.
[CUSTOMER][NEUTRAL] Uh, yeah, but which CPT which procedure code is not covered?
[AGENT][NEUTRAL] Correct, because there are treatment codes.
[CUSTOMER][NEUTRAL] OK. The both the codes are not covered?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Procedure code 93015 and procedure code 78452 is not covered under the patient's plan. Am I right?
[AGENT][NEUTRAL] Yes, what I'm saying is treatment. Those are treatment codes, so treatment, any treatment in a physician's office is not covered, so correct.
[CUSTOMER][NEGATIVE] OK, timely failing to submit the corrected claim.
[AGENT][NEUTRAL] Oh correct a claim there's no timely filing limit.
[CUSTOMER][NEUTRAL] And what will be the mailing address to submit the correct claim?
[AGENT][NEUTRAL] It's actually the same as the claims mailing address.
[CUSTOMER][NEUTRAL] OK. Could you please tell me once again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. And for the time, uh, there is, uh, OK, for the timely filing to submit and I pay, it's the same which you gave me for the credited claim, no timely filing limit.
[AGENT][NEUTRAL] To submit an appeal, it's 180 days from the date that it was processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And what will be the mailing address to submit an appeal?
[AGENT][NEUTRAL] The same mailing address?
[CUSTOMER][NEUTRAL] Is there any specific form for nappy?
[AGENT][NEGATIVE] There is not. Make it to the attention of the pills, please.
[CUSTOMER][NEUTRAL] OK. Attention to appeals. And could you please tell me mm claim number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, do you have a copy of the ELD? The claim number is on that document. It's 356.
[CUSTOMER][NEUTRAL] OK, just.
[AGENT][NEUTRAL] 973 8.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 8. OK. Do you require denied you be while submitting a claim or an appeal?
[CUSTOMER][NEUTRAL] And then.
[AGENT][NEUTRAL] I think you may have already submitted that with the initial claim, so it's not required. You'll just provide documentation as to why the claim is being appealed.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, and what will be the call reference number for our conversation?
[AGENT][NEUTRAL] My name and today's date, [PII], did you have any other questions?
[CUSTOMER][NEUTRAL] Uh, no, I don't have any other questions, but I do have more claims on the file to discuss with you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hey, I can do one more claim and you can also check your status online. Would you like for me to help you set up an account?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEGATIVE] Uh, no, no.
[AGENT][NEUTRAL] OK, I can check one more claim for you. What is that number?
[CUSTOMER][NEUTRAL] And then the member's ID is 1069988.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] And the patient's first name, I would like to spell, it's [PII]
[AGENT][NEUTRAL] Thank you. I have uh all those's first name. I have it here. What's the date of birth?
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[AGENT][NEUTRAL] Thank you and what's the date of service?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Did you say [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 8, OK. And the total charge?
[CUSTOMER][NEUTRAL] $190 even.
[AGENT][NEUTRAL] $190. Thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said [PII] or [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, I do not show that claim received.
[AGENT][NEUTRAL] And I also show that the policy is no longer active as of [PII].
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] Uh, no longer active as of [PII].
[AGENT][NEUTRAL] Uh, the policy became effective [PII].
[AGENT][NEUTRAL] And did you have any other questions, [PII], about this claim?
[CUSTOMER][NEUTRAL] OK. The effective date you gave me is [PII]. Am I right?
[AGENT][NEUTRAL] That's the, the lapse date. It's not, that's the termination date.
[CUSTOMER][NEUTRAL] OK, that's the termination date, [PII].
[AGENT][NEUTRAL] Correct. The effective date is [PII].
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] And no active coverage for this patient?
[CUSTOMER][NEUTRAL] OK, so the member is not active on the date of service and the claim is also not on file, am I right?
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, bear with me just a moment. OK.
[CUSTOMER][NEUTRAL] So could you please tell me when was the last coordination of benefits updated?
[AGENT][NEUTRAL] The effective date of the policy.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] Do, OK. Do you see any other pay listed for this patient?
[AGENT][NEGATIVE] There is no active coverage for this patient.
[CUSTOMER][NEUTRAL] Uh, no, I'm asking about, do you see any other payer listed for this patient?
[AGENT][NEUTRAL] Did you say any other pair?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] As an insurance company?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I do not.
[CUSTOMER][NEUTRAL] OK, and as you gave me before, there is no timely filing to submit the corrected claim and mailing address will be [PII].
[CUSTOMER][NEUTRAL] [PII]. And timely to submit an appeal will be 1 or 2 days from the process date, mailing address will be the same for an appeal and there is no specific form for an appeal. And what will be the call reference number for our conversation?
[AGENT][NEUTRAL] It's the same.
[CUSTOMER][POSITIVE] OK, and [PII], thank you for your assistance. Have a great day. And just one request to you, could you please transfer my call back in the queue.
[AGENT][NEUTRAL] We can't transfer it.
[CUSTOMER][NEUTRAL] So you can't transfer. I need to call back?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, no worries, thanks for your assistance. Have a great day.
[AGENT][POSITIVE] You're welcome thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Yeah.