AccountId: 011433970860
ContactId: 0c19a15c-d288-4f6a-b379-1ba409822530
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1047500 ms
Total Talk Time (AGENT): 284073 ms
Total Talk Time (CUSTOMER): 493242 ms
Interruptions: 5
Overall Sentiment: AGENT=-0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/0c19a15c-d288-4f6a-b379-1ba409822530_20250502T20:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling for the provider to check on a claim status. Please be informed that this call is being recorded and monitor, monitored for quality and training purposes. May I know how can I help you with the patient's information or the provider's information?
[AGENT][NEUTRAL] May I have a callback number?
[CUSTOMER][NEUTRAL] It's [PII]. No extension, it's a direct line.
[AGENT][NEUTRAL] May I have the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 01660278 M as in Mike, L as in Lima.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is.
[CUSTOMER][NEUTRAL] I would like to spell the last name. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] The date of birth will be [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying the policy you're calling in for status. May I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total bill amount will be.
[CUSTOMER][NEUTRAL] $500 so the total amount will be $58 even.
[AGENT][NEUTRAL] 58.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and the date of service?
[AGENT][NEUTRAL] It's [PII] or [PII], correct?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And I'm pulling that information up for you now.
[AGENT][NEUTRAL] And you can also check claim status via our secured portal that is [PII].
[AGENT][NEUTRAL] And for that claim, it does show that we received it on [PII]. It was processed on [PII].
[AGENT][NEUTRAL] That claim number is 357.
[AGENT][NEUTRAL] 2741. It shows that it denied that office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK. And could you please tell me your name once again? I didn't catch your name.
[AGENT][NEUTRAL] It is [PII]. Would you like me to spell that for you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh no.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] And give me a minute.
[CUSTOMER][NEUTRAL] Uh, yeah, I have a few questions to ask. Could you please tell me
[CUSTOMER][NEUTRAL] OK. Office visits are not covered under this member and could you please tell me the which CPT code is not covered under this, uh, under
[CUSTOMER][NEUTRAL] Under the patient's policy?
[AGENT][NEUTRAL] You said which CPT code?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, CPT code, procedure code.
[AGENT][NEUTRAL] That will be the procedure code that was billed.
[CUSTOMER][NEUTRAL] So I'm asking about which procedure code is not covered under the member's plan.
[AGENT][NEGATIVE] The procedure code that was billed was the total amount of the $58. That procedure code is the one that denied.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, but which CPT code 994144157 is not covered under the member's plan.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Office procedures period is not covered under the member's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So 994-4159944195 is not under the member's plan, am I right?
[AGENT][NEGATIVE] I can only advise you, I can't tell you about what CPT code is not covered, but the one that we denied is the one that was submitted in for $58 which is the 99441. That procedure code that was billed denied office visits are not covered.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh so
[CUSTOMER][NEUTRAL] So 99441 is not covered under the member's plan. Am I right? Is dinner for office visits are not covered under the member's plan. Am I right?
[AGENT][NEUTRAL] OK, as I previously stated, the claim denied is not covered.
[CUSTOMER][NEUTRAL] OK, and what will the timely filing to submit the corrected claim?
[AGENT][NEGATIVE] We have no timely filing.
[CUSTOMER][NEUTRAL] And what would be the meeting address to submit the corrected claim?
[AGENT][NEUTRAL] The mailing address is the same mailing address which is [PII].
[AGENT][NEUTRAL] And that is [PII].
[AGENT][NEUTRAL] With the zip code of [PII].
[AGENT][NEUTRAL] [PII] and what I've advised you was that for this member's policy, anything rendered within an office for an office visit is not covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yeah, timely filing to submit an appeal.
[AGENT][NEGATIVE] As I previously stated, there's no timely filing.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh it will be sent to the same address which you gave me.
[AGENT][NEUTRAL] That is correct, or you can submit it in via fax. Would you like that fax number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, bear with me just a moment.
[CUSTOMER][NEUTRAL] And is there any specific form for a nappy?
[AGENT][NEUTRAL] No specific form.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And then you is required by submitting an appeal or a corrected claim.
[AGENT][NEUTRAL] You said it's to deny EOB?
[CUSTOMER][NEUTRAL] Uh, yeah, it's required by submitting a corrected claim or uh appeal.
[AGENT][NEUTRAL] No, it's not required.
[CUSTOMER][NEUTRAL] Could you please provide me the fax number?
[AGENT][NEUTRAL] The fax number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] and that is attention claims department but if you're submitting an appeal, you would put attention appeals.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] And could you please uh tell me your name once again? I forgot your name.
[AGENT][NEUTRAL] OK, this will be my last time repeating it. It is [PII] with the last initial of [PII] and today's date as the call reference.
[CUSTOMER][NEUTRAL] OK. And could you please assist me with, assist me with two more claims?
[AGENT][NEUTRAL] May I have the next policy number or is it a different, is it the same policy number?
[CUSTOMER][NEUTRAL] Uh, different policy number because the member is different.
[AGENT][NEUTRAL] May I have that, please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's 01816168.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is [PII] [PII] and the last name will be [PII], and the date of birth will be [PII]. Uh yeah. The date of service.
[AGENT][NEUTRAL] Data service and total bill.
[CUSTOMER][NEUTRAL] will be [PII] and the amount will be
[CUSTOMER][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] OK 444801.
[AGENT][NEUTRAL] OK, so the date, the year you're giving me is [PII]. Is this for [PII]?
[CUSTOMER][NEUTRAL] No, it's for the [PII] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the total charges is $9,232 even.
[AGENT][NEUTRAL] And for the data service it is showing that no claim is on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For the date of service it's showing no claim on file.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, bear with me, give me a minute.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And $9,232 1,202 dollars.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Could you please tell me the patient active on the date of service.
[AGENT][NEUTRAL] The effective date is showing [PII] and currently active.
[CUSTOMER][NEUTRAL] And could you please tell me when was the last coordination of benefits updated?
[AGENT][NEUTRAL] We wouldn't have any information of the coordination of benefit.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, are you primary or secondary?
[AGENT][NEUTRAL] We're secondary.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, and don't uh.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] And there is no timely filing limit for the claim submission, am I right? And it will go to the same mailing address and what will be the payer ID.
[AGENT][NEUTRAL] The electronic payer ID is 60.
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] 60801 and the preferred mode of submission will be both mail and electronic.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] You can submit it mail, fax, or our secured portal.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and bear with me just a moment.
[CUSTOMER][NEUTRAL] Shall we move to the next claim?
[AGENT][NEUTRAL] Yes, may I have the next policy number?
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Yeah, sure, my system is thinking. Give me a minute.
[CUSTOMER][NEUTRAL] OK. Uh, the next member ID will be 01807323 M as in Mike, L as in Lima, 8.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the patient's first name is [PII] and the last name is [PII]. Date of birth will be [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have the date of service and total bill?
[CUSTOMER][NEUTRAL] No date of service is [PII] and the total amount will be $555 even.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that is for data service of 1113 of 24 with total bill 555.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, it's not showing a claim on file for that total bill.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And I can see.
[CUSTOMER][NEUTRAL] Do you have any claim on file for $171 even?
[AGENT][NEUTRAL] We do have a claim on file for 171. Is that the claim that you're needing me to review?
[CUSTOMER][NEUTRAL] OK, yeah. $171.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And for that claim it does show that we received it on [PII].
[CUSTOMER][NEUTRAL] Are you there?
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The claim number is 354.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 4245 that claim processed and it denied that the policy was not active at the time of service. It is showing that the term date for this policy is for [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and do you have any recent claim on file for the member?
[AGENT][NEUTRAL] Do we have a recent claim?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, because we have submitted the claim once again on [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Not showing that we have a recent claim that was the only claim that was received, which was in December and the policy was still not active.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] OK. Could you please tell me the uh claim number once again?
[AGENT][NEUTRAL] It is 354-424-5. And is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh yeah, I just want to know.
[CUSTOMER][NEUTRAL] Give me a minute.
[CUSTOMER][NEUTRAL] Just a moment, give me a minute.
[CUSTOMER][NEUTRAL] Uh, so the member was not active on the date of service you're you're talking about that. Am I right?
[AGENT][NEUTRAL] As I previously stated, the policy was not active at the time of service, and the term date for this policy is [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] And what will be the effective date?
[AGENT][NEUTRAL] The effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, bear with me just a moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And do you see any other payer listed for this member?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Are you asking do they have another policy, active policy?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, yeah, yeah. Do you see any of them? No, OK. And the details will be the same which you gave me before, timely filing details will be the same.
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] Yes, we have no timely filing.
[CUSTOMER][NEUTRAL] OK, and call reference number will be your name and today's date. Am I right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, can you please transfer my call back in the queue because I have 2 more claims.
[AGENT][NEUTRAL] OK, you will have to call back in. We can't do a transfer if within the queue, so you have to call back.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] Uh, but the previous rep have, uh, transferred my call back in the queue.
[AGENT][NEUTRAL] We're not allowed to transfer calls so and if you have any more claim status, you would have to call back.