AccountId: 011433970860
ContactId: 1298c509-d1f2-459a-be34-cd21bd24395f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 333399 ms
Total Talk Time (AGENT): 68279 ms
Total Talk Time (CUSTOMER): 156929 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/1298c509-d1f2-459a-be34-cd21bd24395f_20250402T21:37_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Uh hi, [PII]. This is [PII]. I'm calling for a provider's office to check on additional information about a claim which has been denied. Please know this call will be monitored and recorded for quality and training purposes.
[AGENT][POSITIVE] I'd be happy to assist with claim status today, [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Sure. That's [PII] direct line.
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] All right. So the policy number is
[CUSTOMER][NEUTRAL] Just a second. Let me pull it out here, which is 01896417.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And date of birth, [PII].
[AGENT][NEUTRAL] And the date of service of the claim?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And that's with the amount of $223.
[AGENT][NEUTRAL] Thank you for that information. I'm showing the claim was denied because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] Yes, I do see here the service will does not cover another patient's policy. Does that mean the proceed, I mean the service which we have used is not covered under the patient's plan, is what? Is that right?
[AGENT][POSITIVE] That's correct.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Just a second, I'm almost done.
[CUSTOMER][NEUTRAL] All right. And by any chance, do you have any alternative procedure for this one?
[AGENT][NEGATIVE] I don't understand the question.
[CUSTOMER][NEUTRAL] I mean, uh, do you have any alternate procedure for, for this one by any chance?
[AGENT][NEGATIVE] I don't understand the question.
[CUSTOMER][NEUTRAL] Uh, no, ma'am. So what I'm asking is we have built this with the 99213, right? So I'm asking, can you be able to provide any alternate for 99213?
[AGENT][NEUTRAL] No, that's not a covered benefit under the policy. Only treatment and procedures at the visit is covered. The office visit or the physician's charges are not covered.
[CUSTOMER][NEUTRAL] OK. Got it. Is there any specific guidelines were present on this claim apart from this?
[AGENT][NEGATIVE] I don't understand the question.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Shall I go ahead and verify the correct claim mailing address and timely filing limit details with you?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The address is [PII].
[CUSTOMER][NEUTRAL] All right. So the current, mhm.
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Well hold on just a second.
[CUSTOMER][NEUTRAL] The ZIP code is [PII], right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] What would be the timely filing for a credit claim?
[AGENT][NEGATIVE] Um, there's no timely filing.
[CUSTOMER][NEUTRAL] So there's, there'll be no specific time filing for a credited claim.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And also, can I have the appeals details as well, appeal mailing address and the filing limit for an appeal.
[AGENT][NEUTRAL] Um, filing for an appeal, the limit is 60 days from the date of the denial.
[AGENT][NEUTRAL] And the address would be the same.
[CUSTOMER][NEUTRAL] 60 days from the denial address will be the same.
[CUSTOMER][NEUTRAL] All right. And whose attention it has to be for an appeal?
[AGENT][NEUTRAL] Appeals department.
[CUSTOMER][NEUTRAL] Does appeal require any specific form?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Got it. And just wanna confirm the
[CUSTOMER][NEUTRAL] Claim number with you. Let me get that here. Just a second.
[CUSTOMER][NEUTRAL] Almost there.
[CUSTOMER][NEUTRAL] All right. So the claim number is 357-4225. Is that right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Got it. And you said your name is [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII], at last, I just wanna know this information about, uh, this patient is included for uh accident inflammation, the provider rendered the outpatient visit for the evaluation management to the patient. And I'm ready for the reference number for our conversation, [PII].
[AGENT][NEUTRAL] Reference is just my name and today's date and time.
[CUSTOMER][POSITIVE] Thank you for your assistance, [PII]. Have a wonderful day. Bye-bye.
[AGENT][POSITIVE] Thank you for calling APO have a good day.
[CUSTOMER][NEUTRAL] So, the time, about the time, is it, uh, can I, can I have the time?
[AGENT][NEUTRAL] Um, where I am it's [PII]
[CUSTOMER][NEUTRAL] To get the reference number?
[CUSTOMER][POSITIVE] Got it. Thank you once again. Bye-bye.
[AGENT][POSITIVE] Thank you bye bye thank you for calling APL.