AccountId: 011433970860
ContactId: 131967f9-b363-40f9-84be-4f29ed874462
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 709099 ms
Total Talk Time (AGENT): 184090 ms
Total Talk Time (CUSTOMER): 282457 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/131967f9-b363-40f9-84be-4f29ed874462_20250410T20:19_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, hi. Uh, this is [PII] calling from Naples Community Hospital. So, I'm looking for the claim status for 12 members, uh, with two claims. So, can you please help me with that?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, sure, I can assist you with claims. So, may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] Thank you and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure, uh, just give me a moment.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] The member ID is uh oh.
[CUSTOMER][NEUTRAL] OK. It's 0221.
[CUSTOMER][NEUTRAL] 2366 M as in Mary, L as in Lima, 8.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] So the member's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So the date of service is [PII] with the double the amount of $60 285 dollars 2 cents.
[AGENT][NEUTRAL] $285 and how many cents?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 2 cents.
[AGENT][NEUTRAL] 2 cents. OK. And that was [PII], correct?
[CUSTOMER][POSITIVE] Mhm. That's right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and let me pull this EOB for future, you can check claim status online through our website at [PII] and that's just optional. And bear with me, let me pull this ELB.
[CUSTOMER][NEUTRAL] Uh, actually, yes, I do have the portal of access, but unfortunately I don't have the SSN number for this member with me, so I'm not able to pull up the status without SSN number.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. No problem. One moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] All right. So we have a process the claim on [PII]. The claim was denied. The reason for this denial is, let's see.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the rest is just uh it was fully paid by the major medical, so there's nothing else for us to cover.
[CUSTOMER][NEUTRAL] OK. For the CPT code 99214, the office visit are not covered by the patient plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Uh, so, may I know the patient's plan?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] OK, so, uh, so how about the CPT code 93,000?
[AGENT][NEUTRAL] 93,000. That denial is let's see.
[AGENT][NEUTRAL] One
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so based on the explanation of benefits that we receive attached with the claims, it looks like the insured's primary insurance provided full benefits.
[AGENT][NEUTRAL] For that cold.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm sorry, your voice is breaking. Could you please repeat that again?
[AGENT][NEUTRAL] Insured primary insurance provided full benefits. There are no benefits payable for that code.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So there is no benefit payable for this CPT code 93,000, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Uh, so does the patient have any other active coverages?
[AGENT][NEUTRAL] Um, none with us. This is the only one that I can see at this time.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I don't see any other policies.
[CUSTOMER][NEUTRAL] OK. So can you please help me with uh one more patient?
[AGENT][NEUTRAL] OK, let me make a note on this one and you don't need any other information on this one. Do you need the claim number or any other information?
[CUSTOMER][NEUTRAL] Uh, uh, yes, uh, so can I have the claim number? I'm sorry.
[AGENT][NEUTRAL] Mhm. The claim number is 3562174.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, bear with me just a minute let me finalize my notes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You should mail the Indian.
[CUSTOMER][NEUTRAL] We.
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] Uh, yeah, sure. Just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, so the next policy number is.
[CUSTOMER][NEUTRAL] Just one moment. It is 24446. I think this is not the, not the correct member ID. Just give me a moment. Let me try to pull up the original ID for you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you use.
[CUSTOMER][NEUTRAL] So the policy, do you need the policy number or?
[AGENT][NEUTRAL] Mhm, yes, the policy number if you have it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the policy number is 01960154.
[AGENT][NEUTRAL] OK, let me try that.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] So, the name is uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, and what's the date of service and the amount of the plane?
[CUSTOMER][NEUTRAL] It's [PII] with the amount of $349.02.
[AGENT][NEUTRAL] No, [PII], correct?
[CUSTOMER][POSITIVE] Mhm, that's right.
[AGENT][NEUTRAL] OK, let me pull this EOP one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, so this one was processed [PII], and it will be the same denial reasons.
[CUSTOMER][NEUTRAL] OK, so this is also for the same denial. So the 99213 code is, I'm sorry. So the code is not, sorry, the visits are not covered by the patient plan and uh another code 99396 is no benefit payable for the CPT, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, uh, so does this patient have any other insurance?
[AGENT][NEGATIVE] None with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Um, so, anyways, can you please send us an UB through the fax? Is that possible?
[AGENT][NEUTRAL] For this one?
[CUSTOMER][NEUTRAL] Uh, for both?
[AGENT][NEUTRAL] Um, do you have the claim number for the other one? Because I'm out of the other one.
[CUSTOMER][NEUTRAL] Is it possible?
[CUSTOMER][NEUTRAL] Yeah, I do have. So is it possible means I have uh to 5 claims with me, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, definitely, it will help.
[AGENT][NEUTRAL] And you cannot pull them through the portal with the claim numbers?
[CUSTOMER][NEGATIVE] Uh, actually, I'm, uh, but I'm not received the exact, uh, EUB. It shows like something, but it's not like accurate EUB.
[AGENT][NEUTRAL] It it is gonna be the same thing that I'm sending.
[CUSTOMER][NEUTRAL] OK. Anyways, uh, so I do.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] All right, um, so that's it for the day anyways, thank you. Uh, so I do, so can I, so I will download it from the portal also. Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're gonna get it from her, OK, go ahead.
[CUSTOMER][NEUTRAL] Anyways, uh, can I have
[CUSTOMER][NEUTRAL] Mm, yeah. Uh, can I have your first and last name and the call reference number for this call?
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[AGENT][NEUTRAL] And we don't have a reference numbers, you can use my name in today's date.
[CUSTOMER][POSITIVE] OK. Anyways, uh, thank you so much, Ms. So, and it's a nice name too. So, have a great day. Bye-bye. Take care.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] You as well thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.