AccountId: 011433970860
ContactId: 1749be94-b5e5-4baa-8c66-91d9993d3381
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 708960 ms
Total Talk Time (AGENT): 225103 ms
Total Talk Time (CUSTOMER): 182846 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/1749be94-b5e5-4baa-8c66-91d9993d3381_20250306T16:01_UTC.wav
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[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi. My name is [PII] calling from product's office to check on claims and how are you doing today?
[AGENT][POSITIVE] I'm doing good, [PII]. How are you doing today?
[CUSTOMER][POSITIVE] I'm doing good, thank you for asking.
[AGENT][POSITIVE] You're very welcome. I can help you with the claim status. May I get your callback number, sir?
[CUSTOMER][NEUTRAL] Yes, it is [PII]. It's a direct line. And could you please spell out your name for me?
[AGENT][POSITIVE] Thank
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] With your last name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[AGENT][NEUTRAL] You're welcome. And what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The patient's name is [PII]. Date of birth, [PII].
[CUSTOMER][NEUTRAL] The policy number 01740505.
[CUSTOMER][NEUTRAL] M for Mike, L for Lima, 8.
[AGENT][NEUTRAL] OK, let me pull that policy up real quick for us.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then what is the data service and the charge amount for the claim?
[CUSTOMER][NEUTRAL] Date of service is on [PII] with the amount of $638 even.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] is going to be $151.21.
[AGENT][NEUTRAL] OK, and then also what is the name of the facility you're calling for today?
[CUSTOMER][NEUTRAL] So Lincoln Road Dermatology.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, [PII] while I look up this claim and I will be right back.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me. So looking on the data service of [PII] for [PII], I do not find a claim on file.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], you don't find any claim for that?
[CUSTOMER][NEUTRAL] 515
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yes, OK, give me a quick second.
[CUSTOMER][NEUTRAL] Uh, the claim has been submitted electronically to American Public Life Supplement.
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Let me see if he has another policy that's active. He does. Let me check this other policy. I'm gonna put you on a quick hold real quick.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah OK.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], I have the claim pulled up. I found it. The claim number is 356.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 984 8.
[AGENT][NEUTRAL] And it was filed on policy number.
[AGENT][NEUTRAL] 2307424
[AGENT][NEUTRAL] And the claim was denied. We've got uh two remarks. The first one being office visits are not covered by the patient's policy, and the second one is the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. The first one is not covered under the patient's policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. The CPD code 99214, right?
[CUSTOMER][NEUTRAL] You can uh
[AGENT][NEUTRAL] Let me look at.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, that's correct. It's uh office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Yeah, OK, fine. And uh may I know the second CPD code which was denied?
[AGENT][NEUTRAL] 17,110 and 17,000 are denied because it's not covered when performed in doctor's office or clinic.
[AGENT][NEUTRAL] Because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Oh, all the three line item has been denied, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, fine. And uh
[CUSTOMER][NEUTRAL] Offers which are not under the patient's policy. Let me have a look.
[CUSTOMER][NEUTRAL] Give me a quick second.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Give me a quick second. Let me check in my end.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, fine. upon checking in my and I could see here that
[CUSTOMER][NEUTRAL] It will cover under the patient's policy.
[CUSTOMER][NEUTRAL] So, I hope it has been denied incorrectly. Could you please send the claim back for the process?
[AGENT][NEUTRAL] You're you're more than welcome to send a claim correction if you need to, and there's not a time limit for that and you'll need to send a letter why it needs to be corrected.
[AGENT][POSITIVE] But it's been processed correctly.
[CUSTOMER][NEUTRAL] Yeah, OK. Before that, could you please provide, mhm.
[AGENT][NEUTRAL] On this end.
[CUSTOMER][NEUTRAL] Yeah, OK. Thank you so much, [PII]. Could you please provide me the claim received and denied date?
[AGENT][POSITIVE] Yes sir, let me look real quick for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, the claim was received on [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's been denied for offices did not covered under the patient's policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, for this, uh, for this time for me to get the payment.
[CUSTOMER][NEUTRAL] What can we do for this?
[CUSTOMER][NEUTRAL] Give me a quick second.
[CUSTOMER][NEUTRAL] Let me have uh one more look.
[CUSTOMER][NEUTRAL] OK, fine. So to get the payment for this claim, uh, could you please provide me the guidelines?
[CUSTOMER][NEUTRAL] How to get a payment for this plan?
[AGENT][NEGATIVE] Uh, we don't have guidelines. We don't have guidelines. We've processed the claim and it's been denied.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And is there any possibility for to send the car claim or appeal?
[AGENT][NEUTRAL] Yes, you can send an appeal.
[CUSTOMER][NEUTRAL] Mhm. And could you please provide me your mailing address?
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Yes sir, um, you have 180 days from the date the claim was initially processed and you'll need to send a letter as to why you want to appeal.
[CUSTOMER][NEUTRAL] Yes, go ahead.
[AGENT][NEUTRAL] And you can send it to APL claims.
[AGENT][NEUTRAL] And that is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yeah, OK. Thank you so much. I mean the filing limit is 180 days, and could you please provide me the fax number?
[AGENT][NEUTRAL] Yes, the fax number is [PII].
[CUSTOMER][NEUTRAL] [PII] and the timely filing is 180 days. And may I have your attention?
[AGENT][NEUTRAL] Claims
[CUSTOMER][NEUTRAL] Attention to claims, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yeah, OK, fine. Thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My claim number is going to be 3569848, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And could you please provide me the uh call reference number?
[AGENT][NEUTRAL] Yes, sir, you can use my name [PII] in today's date.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you so much. Thank you so much for your assistance. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're very welcome, [PII]. Is there anything else I can help you with before we go today?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] All right. Well, you have a wonderful day and thank you for calling APL.