AccountId: 011433970860
ContactId: 0f7df64f-fbce-4147-91fb-46ea138b6039
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 767859 ms
Total Talk Time (AGENT): 230798 ms
Total Talk Time (CUSTOMER): 276144 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/0f7df64f-fbce-4147-91fb-46ea138b6039_20250506T19:44_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, [PII]. My name is [PII] calling for the provider to check on a claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. So may I know how can I help you with the patient's information or the provider's information? And Tarika, I'm looking for the corrected claim stats.
[AGENT][NEUTRAL] May I please have a callback number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Now extension is to be declined.
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number will be 01838979.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII]. The date of birth will be [PII].
[AGENT][NEUTRAL] And you're calling in for status of claim. May I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] Yeah. The date of service is [PII] and the total bill amount will be 1.
[CUSTOMER][NEUTRAL] OK, give me for the bill amount.
[CUSTOMER][NEUTRAL] The total bill amount will be $1,008 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah. And do you want when we have submitted the corrected claim?
[AGENT][NEUTRAL] No, I will be able to pull that up.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] So I do see that we have 2 claims on file and I'm pulling the 2nd 1 up for you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] C.
[AGENT][NEUTRAL] So for the second one we received it on [PII]. It was processed on [PII]. That claim number is 3576006. It shows that that claim denied as a duplicate of the previous submitted claim.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] And what's the previous claim status?
[AGENT][NEUTRAL] The previous claim shows that it denied.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] That the per occurrence max had already been met, so the member had no other benefits available.
[CUSTOMER][NEUTRAL] What's the claim received date and denied date and the claim number?
[AGENT][NEUTRAL] For the first one?
[CUSTOMER][NEGATIVE] Yeah, for, yeah, which uh has been denied for the service max.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So that one was received on [PII]. It was processed on [PII], and that claim number is 354.
[AGENT][NEUTRAL] 7045.
[CUSTOMER][NEUTRAL] OK, and bear with me just a moment.
[CUSTOMER][POSITIVE] OK, perfect. Give me a minute.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. [PII], could you please tell me what are the allowed services amount per time frame?
[AGENT][NEUTRAL] Let me pull that up for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] At that time of service, verification of coverage does not guarantee the payment of the claim. This member had up to $200 per occurrence.
[CUSTOMER][NEUTRAL] $200.
[AGENT][NEUTRAL] Yes, per occurrence.
[CUSTOMER][NEUTRAL] Per occurrence.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And when, when was this type of service bill? When was this type of service bill last?
[AGENT][NEUTRAL] I can only give you information on the claims that was submitted in.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] By this provider and the two that you requested.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what is the time period to build this service?
[AGENT][NEUTRAL] What is the time period?
[CUSTOMER][POSITIVE] Yeah, to build the service again.
[AGENT][NEGATIVE] You have already submitted it in and it's been reviewed, they don't have any benefits available.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And I'm asking about what is the time period to build the service again?
[AGENT][NEUTRAL] OK, maybe I'm not understanding the question.
[AGENT][NEUTRAL] What do you meaning what is the time period of billing the services?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That means what will be the time period to build this service means.
[AGENT][NEUTRAL] Are you asking if we have a timely filing?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, we don't have any timely filings for submitting claims.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and what will be the, OK, there will be no time falling for the corrected claim also, am I right?
[AGENT][NEUTRAL] You're more than welcome to submit or correct the claim, but the member has no more benefits, so it's gonna deny as a duplicate of the previous claim as well.
[CUSTOMER][NEUTRAL] Yeah I know but it's just for my documentation purpose.
[AGENT][NEGATIVE] We have no timely filing for submitting any claims.
[CUSTOMER][NEUTRAL] Could you please help me with
[CUSTOMER][NEUTRAL] Yeah, and for the appeals?
[AGENT][NEGATIVE] We have no timely filing for appeals either.
[CUSTOMER][NEUTRAL] And what will be the mailing address to submit the corrected claim?
[AGENT][NEUTRAL] For the corrected and appeals that will be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] And is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Is there any specific form for annay?
[AGENT][NEUTRAL] There's no specific form if you would like to just put on there um appeal or reconsideration.
[AGENT][POSITIVE] You're more than welcome to do that as well.
[CUSTOMER][NEUTRAL] OK, and the call reference number will be your name and today's date. Am I right?
[AGENT][NEUTRAL] Yes, it's first name [PII], last initial of [PII] and today's date.
[CUSTOMER][NEUTRAL] OK, can you help me with the one more claim 2 more claims?
[AGENT][NEUTRAL] May I have that next policy number please or is it the same number?
[CUSTOMER][NEUTRAL] Huh?
[CUSTOMER][NEUTRAL] Different member and the policy number will be 02506058.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] Date of birth will be [PII].
[AGENT][NEUTRAL] OK, and may I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] And the total amount will be
[CUSTOMER][NEUTRAL] $212 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And for that claim it does show we received it on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What are you needing for me to repeat?
[CUSTOMER][NEUTRAL] When you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] Uh, I didn't get the received it.
[AGENT][NEUTRAL] OK, it was received on [PII], and it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 5.
[AGENT][NEUTRAL] That claim number is 357.
[AGENT][NEUTRAL] 5467.
[AGENT][NEUTRAL] And it shows that it denied that office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes uh.
[CUSTOMER][POSITIVE] It's uh it's like but it's nice.
[CUSTOMER][NEUTRAL] And do you have any recent claim on file?
[AGENT][NEUTRAL] The only claim we have is the one that you're questioning about.
[AGENT][NEUTRAL] And that's the information that I gave you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, bear with me just a moment. I have a few questions to ask.
[CUSTOMER][NEUTRAL] Could you please tell me which CPT code is not covered under the patient's policy?
[AGENT][NEUTRAL] You only submitted one claim, one line, so the office visit denied is not covered.
[CUSTOMER][NEUTRAL] OK, 99213 CPT code is not covered. Am I right?
[AGENT][NEGATIVE] Whatever procedure was submitted is not covered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And the details which you gave me uh further will be the same, timely filing and mailing address.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Shall we move to the next claim?
[AGENT][NEUTRAL] Yes, may I have that please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The next member ID is 778679.
[AGENT][NEUTRAL] OK, I'm gonna see if that's one of our numbers, but it don't look like one of our policy numbers.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and last name is [PII]. Date of birth will be [PII].
[AGENT][NEUTRAL] OK, so I'm not seeing that this member have medical benefits under us. You would have to contact Will TPA and are you ready for that information?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, so we move to the next one.
[AGENT][NEUTRAL] OK. How many more do you have because you did state you only had 2 left.
[CUSTOMER][NEUTRAL] No, done with it, done with it. Sorry for that, done with it.
[AGENT][NEUTRAL] OK, did you have any more that you needed for me to review?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK. Well, I do wanna thank you.
[CUSTOMER][POSITIVE] Thanks for your assistance and have a great day.
[AGENT][POSITIVE] You're welcome and thank you for calling American Public Life. Have a great day as well.