AccountId: 011433970860
ContactId: 1df3f00f-7759-43f1-8912-c3133b62edca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1464260 ms
Total Talk Time (AGENT): 361874 ms
Total Talk Time (CUSTOMER): 783443 ms
Interruptions: 17
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/1df3f00f-7759-43f1-8912-c3133b62edca_20250429T12:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for the provider to check on the 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?
[AGENT][NEUTRAL] Yes, do you have the policy number on you?
[CUSTOMER][NEUTRAL] Oh yeah, I do have the policy number. The policy number is 002558162.
[AGENT][POSITIVE] OK, perfect, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and [PII], what's a good call back number in case our call gets dropped?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. No extension it's a direct line.
[AGENT][NEUTRAL] OK, thank you. And then patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII], and the date of birth will be [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, perfect, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then do you have a data service and a charge amount?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII] and the charge amount is $1,304.80.
[AGENT][POSITIVE] OK, thank you. So it looks like.
[AGENT][NEUTRAL] You will have to contact Web TPA for any claims questions with this policy.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK, so this policy is handled by the TPA?
[AGENT][NEUTRAL] Yes, it's Web TPA and I have their phone number if you would like it.
[CUSTOMER][NEUTRAL] And you can get.
[CUSTOMER][NEUTRAL] OK, you can provide me.
[AGENT][NEUTRAL] OK. It is [PII].
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, TPA.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, so I have more two claims to, uh, to do, we can discuss these two claims, then you can transfer my card.
[AGENT][NEUTRAL] Yes, of course. Uh, what's the next policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. The next policy number, give me a minute.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And then I wanted to inform you that we do have an OSC website that you can log on to and check claim status.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the next policy number is.
[CUSTOMER][NEUTRAL] 02491
[CUSTOMER][NEUTRAL] 250 M as in Mike L as in Lima 8 so I already have all the details so I will just go with the.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And this is for claim status as well?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And then patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII] and the patient's date of birth will be [PII].
[AGENT][POSITIVE] OK, perfect. Thank you.
[CUSTOMER][POSITIVE] I'm good thank you so.
[AGENT][NEUTRAL] OK, data service and charge amount please.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Yeah, the date of service is September, sorry, the date of service is [PII] and the charges is for, OK, give me a minute for the charges.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] See if I can.
[CUSTOMER][NEUTRAL] Yeah, the charges is $255 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, just one moment while I look up this claim.
[AGENT][NEUTRAL] And then what provider's office are you calling from?
[CUSTOMER][NEGATIVE] I'm calling from Boring Queen Health, uh, Boring Queen Healthcare Center.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so it looks like for this claim.
[AGENT][NEUTRAL] The denial code is this policy does not provide a benefit for services in which no charges were incurred.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Means the uh services are not covered under the member's plan.
[AGENT][NEUTRAL] No, that is correct. So they
[AGENT][NEUTRAL] The patient has a meddling policy, and if their primary insurance does not pay anything, then that means the secondary policy will not cover anything as well.
[CUSTOMER][NEUTRAL] 14.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] full pay is $30.
[AGENT][NEUTRAL] Sole was
[CUSTOMER][NEUTRAL] OK, so when you guys receive, uh, when you guys received the claim?
[AGENT][NEUTRAL] OK, give me just one minute. Would you like that claim number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. It is 355.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] 8459.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the received date was [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And the uh email address is [PII].
[AGENT][NEUTRAL] And the process date was [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And do you guys receive any recent claim? Uh, because we have submitted the claim, just a moment on [PII].
[CUSTOMER][NEUTRAL] Do you have any recent claim on file?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the claim number for this one is 25051.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] There is no claim on file for [PII].
[CUSTOMER][NEUTRAL] OK, just a moment. Let me make a note. Give me a minute.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you're fine.
[CUSTOMER][NEUTRAL] OK, could you please tell me the denial reason once again.
[AGENT][NEUTRAL] Yes, it says this policy.
[AGENT][NEUTRAL] Does not
[CUSTOMER][NEUTRAL] So first you know.
[AGENT][POSITIVE] Provide a benefit.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For services.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] In which
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No charges.
[AGENT][NEGATIVE] were incurred.
[CUSTOMER][NEUTRAL] OK, so the services are not covered under the member's plan, am I right? OK, and you stated maybe your primary has not paid anything, so you're not going to pay anything.
[AGENT][POSITIVE] That is correct.
[AGENT][POSITIVE] That is correct. Mhm.
[CUSTOMER][NEUTRAL] OK, give me a minute.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Just a minute.
[AGENT][POSITIVE] You're fine. Take your time.
[CUSTOMER][NEUTRAL] And you guys received the, yeah, and you guys have received the claim on [PII] and processed on [PII], means denied on [PII]. Am I right?
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] A bag.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, so received on [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] process date.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and could you please tell me if the service is not covered under the provider's contract or the pay guidelines?
[AGENT][NEUTRAL] It is not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And could you please tell me which CPT is not covered?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Yes, of course.
[CUSTOMER][NEUTRAL] On how
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And the procedure code is 99213.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and could you please tell me timely filing to submit the correct claim?
[AGENT][NEUTRAL] There is no filing limit to submit a claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And could you please tell me mailing address to submit the corrected claim?
[AGENT][NEUTRAL] Yes, of course. So the claims address is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, and what will be the timely filing to submit an appeal?
[AGENT][NEUTRAL] That is, hold on just one second, let me look that date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I yeah.
[AGENT][NEUTRAL] OK, so the appeal must be filed 180 days after receipt of the written notice of adverse benefit determination.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, sorry, I didn't get it. Could you please uh tell me once again 1 or 2 days after?
[AGENT][NEUTRAL] Of course, 180 days.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's it, 180 days?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, uh, it's, uh, from the received date or the denial date.
[AGENT][NEUTRAL] Yes, from the receipt of the written notice of adverse benefit determination. So that would be.
[CUSTOMER][NEUTRAL] $341 is $73 right?
[AGENT][NEUTRAL] Let me go back really quick. That would be January.
[CUSTOMER][NEUTRAL] Uh let me see.
[AGENT][NEUTRAL] 459
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, it's from 180 days from the received receipt of notice of benefit determination date.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what will be the mailing address to submit an update?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To submit an appeal, that would be [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] May I know the listing number?
[CUSTOMER][NEUTRAL] OK. Is there any specific form for a nappy?
[AGENT][NEUTRAL] So you would just put attention to appeal department.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] And no specific form.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And the claim number is 3558459.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] And is denied, you will be required while submitting an appeal or a claim?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Or what will be the call reference number for our conversation?
[AGENT][NEUTRAL] It would be my first name, [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Last initial [PII] and then today's date.
[CUSTOMER][POSITIVE] OK, [PII], thanks for your assistance. OK, [PII], could you please help me with the lastly?
[AGENT][NEUTRAL] Of course. Do you have that policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I do have the policy number. Just bear with me 2 seconds. OK, the policy number is.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02000226 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I can.
[AGENT][NEUTRAL] OK. And then patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII]. Sorry, patient's first name is [PII] and the last name is [PII] and the date of birth will be [PII].
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] And are we checking claim status as well?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 590 E as in Edward 00114 right?
[CUSTOMER][NEUTRAL] OK, I just require the field on the fact that we need.
[AGENT][NEUTRAL] OK, and it looks like this policy is no longer active.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This policy termed on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] [PII]. OK. And the date of service is [PII].
[CUSTOMER][NEUTRAL] OK, so the member is not active on the date of service.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] OK, what will be the effective date of the member?
[AGENT][NEUTRAL] The effective date was [PII].
[CUSTOMER][NEUTRAL] I think so.
[CUSTOMER][NEUTRAL] OK, so do you have any claim on file or you, you have not got the claim or you have not processed the claim? What's the status right now?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see, what is the data service that you have?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's.
[CUSTOMER][NEUTRAL] And could you spell me your name and address?
[AGENT][NEUTRAL] OK. Yes, it looks like we did receive that claim and that claim number is 359.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 4818.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Uh, provided all this.
[AGENT][NEGATIVE] And it was denied.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Due to their policy being no longer active at the time of service.
[CUSTOMER][NEUTRAL] OK. What's the received date and the denial date?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I don't.
[AGENT][NEUTRAL] Sorry, just one moment. My computer is thinking.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] OK, so it looks like the received date is.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the process date is [PII] as well.
[CUSTOMER][NEUTRAL] OK. And could you please tell me when was the last coordination of benefits updated?
[CUSTOMER][NEUTRAL] C O B
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Especially.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so it looks like that was [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] OK, so do you see any other pay listed for this patient?
[AGENT][NEGATIVE] I do not, no.
[CUSTOMER][NEUTRAL] What will be the, OK, the timely filing you gave me for the corrected claim will be the same and mailing address also the same and what will be the timely filing for an appeal?
[AGENT][NEUTRAL] That would be 180 days.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mm OK. And from the received a denial date anything like that?
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It would be
[AGENT][NEUTRAL] It says 180 days after receipt of the written notice of adverse benefit determination. So for this one, it would be
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Really
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, and mailing Ail's mailing address will be the same which you gave me before, am I right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And the other details will be the same which you gave me for the previously.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK, what will, uh, so the call reference number will be the same and you guys not required the ID will be while submitting a claim or a pay.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK. So [PII], thanks for your assistance. And [PII], could you please uh transfer my call to the TPA department.
[AGENT][NEUTRAL] Yes, of course. Just one moment, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Welcome to Web TPA, the administrator for the limited benefit health insurance program underwritten by American Public Life Insurance Company. If this is an emergency, please.
[AGENT][NEUTRAL] OK, Mr. [PII], I'm gonna swap you over right now, OK?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] OK, thank you and have a good day. Thanks for calling APL.
[CUSTOMER][NEUTRAL] Thank you. At [PII]. If you're a physician or hospital calling to verify medical eligibility, please press one.