AccountId: 011433970860
ContactId: 18b5d259-de8e-471a-b002-4ec6d295bb3a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 362279 ms
Total Talk Time (AGENT): 139115 ms
Total Talk Time (CUSTOMER): 80754 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/18b5d259-de8e-471a-b002-4ec6d295bb3a_20250219T19:46_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. My name is [PII] calling from the doctor's office. I'm checking on claim status.
[AGENT][POSITIVE] Well [PII], it would be my pleasure to assist you. What is the callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] That line
[CUSTOMER][NEUTRAL] Yes, 023.
[CUSTOMER][NEUTRAL] 61879 M as in Mike. L as in Larry.
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] The patient's name and date of birth, please?
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Man man you know vast cash.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alright thank you and it would be a pleasure to assist you with that claim status. What was the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the bill amount please?
[CUSTOMER][NEUTRAL] $305.72.
[AGENT][NEUTRAL] And the name of the facility?
[CUSTOMER][NEUTRAL] [PII] [PII], [PII].
[AGENT][NEUTRAL] Alright, thank you [PII]. [PII], we did receive that claim on 5-28-24.
[AGENT][NEUTRAL] Claim was processed on 529-24.
[AGENT][NEUTRAL] The 99215 was denied as office visits are not covered for the policy guidelines.
[AGENT][NEUTRAL] And the procedure CPT code 96127 was denied as.
[AGENT][NEUTRAL] Procedure is not covered when performed in a doctor's office.
[CUSTOMER][NEUTRAL] So this uh 99215 is not cover under the patient plan.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What type of plan, this one?
[AGENT][NEUTRAL] It's a secondary cap policy, like a supplemental.
[CUSTOMER][NEUTRAL] No, please.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I have the claim number.
[AGENT][NEUTRAL] Yes, the claim number is 346.
[AGENT][NEUTRAL] 1636
[CUSTOMER][NEUTRAL] Can I have one more bit of service for the same patient?
[AGENT][NEUTRAL] Well, I'll be happy to help you with that other data service. What's that next data service?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] This one is [PII].
[AGENT][NEUTRAL] And what is that bill amount please sir?
[CUSTOMER][NEUTRAL] $227.56.
[AGENT][POSITIVE] Alright thank you.
[AGENT][NEUTRAL] Same provider?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It's the same provider?
[CUSTOMER][NEUTRAL] Yes, same provider.
[AGENT][NEUTRAL] Alright, thank you. I was showing that claim we received on [PII] and processed on [PII].
[AGENT][NEUTRAL] And the CPT 99214 was denied as office visits are not covered for the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, can I have the claim number?
[AGENT][NEUTRAL] 3461518
[CUSTOMER][NEUTRAL] I find limit to submit the pay?
[AGENT][NEUTRAL] Appeal of timely filing is 180 days from the date of denial.
[CUSTOMER][NEUTRAL] Thank you. For reference number. Happen to have fax number to submit the claim, I mean, to submit the appeal?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Can I have the call reference number?
[AGENT][NEUTRAL] And the call reference number would be my name and today's date, and I spell my name [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, [PII] thank for your assistance. Have a great day.
[AGENT][POSITIVE] It has been my pleasure to assist you today, [PII]. Thank you for calling APL. Hope you have a wonderful day as well. Take care.
[CUSTOMER][POSITIVE] Thank you bye.
[AGENT][NEUTRAL] Bye bye.