AccountId: 011433970860
ContactId: 20a3f937-588d-4dce-a988-b41639e72597
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 602390 ms
Total Talk Time (AGENT): 104213 ms
Total Talk Time (CUSTOMER): 292460 ms
Interruptions: 3
Overall Sentiment: AGENT=0, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/20a3f937-588d-4dce-a988-b41639e72597_20250502T13:58_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling for the provider to check on a claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. May I know how can I help you with the patient's information or the provider's information?
[AGENT][NEUTRAL] Yes, I can help you with claim status. [PII], do you have a good callback number?
[CUSTOMER][NEUTRAL] It's [PII]. No extension. It's a direct line.
[AGENT][NEUTRAL] And the policy number of the patient?
[CUSTOMER][NEUTRAL] Uh, yeah, the policy of the policy number of the patient is 02441374.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And patient 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].
[AGENT][NEUTRAL] And date of service and bill charges?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The service is [PII].
[CUSTOMER][NEUTRAL] And the bill charges is $525 even.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh, we received the claim on [PII].
[AGENT][NEUTRAL] Process 219.
[CUSTOMER][NEUTRAL] Uh, is the claim
[CUSTOMER][NEUTRAL] Is the claim paid?
[AGENT][NEUTRAL] I, I was giving you the status process it on [PII].
[CUSTOMER][NEUTRAL] Uh, no, I
[CUSTOMER][NEUTRAL] Actually, I have the information about the claim as per the previous notes. One of our representatives have called you guys on [PII] and spoke with one of your representatives and
[CUSTOMER][NEUTRAL] He got that the claim, and he spoke to [PII] and as per the claim was processed on [PII] I right? [PII] and allowed and paid amount is the same of $75 even, am I right?
[AGENT][NEUTRAL] Yes, we paid 75, correct?
[CUSTOMER][NEGATIVE] And there is no members responsibility and.
[CUSTOMER][NEUTRAL] Include the flat or the services contacted.
[AGENT][NEUTRAL] And we don't determine member responsibility.
[CUSTOMER][NEUTRAL] Yeah, and the check and the payment was done via the check and check number is 2028757. Am I right?
[AGENT][POSITIVE] Yeah, that's correct.
[CUSTOMER][NEUTRAL] OK, and the claim number will be 3566021.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And so could you please send me the copy of EUB?
[AGENT][NEUTRAL] OK, your fax number?
[CUSTOMER][NEUTRAL] Give you some
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And [PII], could you please tell me, uh,
[CUSTOMER][NEUTRAL] The CPT code 992-0325 has been denied. So why the CPT code has been denied, could you please tell me?
[AGENT][NEUTRAL] There's a benefit of $75 maximum under the policy for this for these services. So,
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEGATIVE] I didn't get it. I didn't get it.
[AGENT][NEUTRAL] We pay a maximum of $75 per the plan policy.
[CUSTOMER][NEUTRAL] OK, so you have paid the $75 the maximum amount.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, give me a minute.
[CUSTOMER][NEUTRAL] Uh, so it's paid for the maximum dollars.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Because it was maximum 5 So the uh so the services are not covered under the member's plan because it was paid maximum dollars.
[AGENT][NEUTRAL] The office visit was allowed, and we paid $75 maximum. The plan only pays $75 maximum for office visits.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And I
[CUSTOMER][NEUTRAL] So this plan only covers maximum uh $75 as a maximum budget.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, bear with me, [PII]. I have a few questions to ask. Give me a minute.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK, [PII], bear with me. My system is loading. Just a moment. I will not take a hold. I'm sorry for that.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Could you please tell me uh
[CUSTOMER][NEUTRAL] OK. So could you please tell me when was the, it, when was it denied? It was denied on [PII]. Am I right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And when was you guys received the claim?
[AGENT][NEUTRAL] 2 1325.
[CUSTOMER][NEUTRAL] OK. And what is the allowed dollar amount for the services?
[AGENT][NEUTRAL] This is a supplemental policy, so it doesn't allow anything. It just pays a certain dollar amount for the policy. The maximum payable is $75 for office visits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] It's not a PPO plan, it's not an HMO plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So it's a supplement policy so it does not allow anything.
[AGENT][NEUTRAL] Just pays a dollar amount based on the policy.
[CUSTOMER][NEUTRAL] Medication
[CUSTOMER][NEUTRAL] OK. And when was the last service billed? Could you please tell me?
[AGENT][NEUTRAL] When was the last service billed? Well, your date of service was [PII].
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah, that's your date of service that you gave me? Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please tell me the timely filing, uh, timely filing to sub uh submit the corrected claim?
[AGENT][NEGATIVE] There's no timely filing?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What will be the mailing address to submit the corrected claim?
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] timely file to submit an appeal.
[AGENT][NEUTRAL] 180 days from the process date.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] What will be the mailing address to submit an appeal?
[AGENT][NEUTRAL] Same address.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, is there any specific form for an update?
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And is there any specific form for an appeal?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] No, there's not. I said no. Yeah.
[CUSTOMER][NEUTRAL] OK. And what will be the claim number?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I just faxed you the EOB's 356-602-1.
[CUSTOMER][NEUTRAL] 356-602-1. OK. And what will be the call reference number for our conversation?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][POSITIVE] OK, [PII], thanks for your assistance. I just have one claim for uh for the day.
[AGENT][POSITIVE] OK, thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Yeah.