AccountId: 011433970860
ContactId: 2a9cf3a6-5aa3-43c9-9881-89dccd44e988
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1652000 ms
Total Talk Time (AGENT): 571772 ms
Total Talk Time (CUSTOMER): 622829 ms
Interruptions: 11
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/2a9cf3a6-5aa3-43c9-9881-89dccd44e988_20250514T12:34_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII] calling for the provider 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, please, if I can have the policy number.
[CUSTOMER][NEUTRAL] Yeah, uh, the policy number is 01719419.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII]. The date of birth will be [PII].
[AGENT][POSITIVE] I appreciate that. [PII], is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh yeah, sure. It's [PII]. It's a direct line.
[AGENT][POSITIVE] I appreciate that. Thank you. And what is the date of service that we're looking for?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] I appreciate that. Is there a particular building in the house?
[CUSTOMER][NEUTRAL] Uh, it's, the bill amount will be $225 even.
[AGENT][NEUTRAL] Thank you. The claim number on this is 35.
[AGENT][NEUTRAL] 80
[AGENT][NEUTRAL] 95, excuse me, 935. Excuse me, let me, let me say this again. 95.
[AGENT][NEUTRAL] 80935, that is the claim number and it looks like we received your claim. Let's see what we have here.
[AGENT][NEUTRAL] It looks like we received your claim.
[CUSTOMER][NEUTRAL] And can
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Could you please repeat the claim number once again? Your voice was breaking.
[AGENT][NEUTRAL] Uh yes, it's 35.
[AGENT][NEUTRAL] 80
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 935.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] We processed it on [PII].
[AGENT][NEUTRAL] 2025. Now [PII], these policies don't cover that office business.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So the office visit is not covered.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] On these policies, so the, uh, so the claim that under the member's plan, the policy does not pay for the office visit.
[CUSTOMER][NEUTRAL] Under the member's plan?
[CUSTOMER][NEUTRAL] I just came from the.
[CUSTOMER][NEUTRAL] that.
[AGENT][NEGATIVE] So, um, that will not be uh covered. Now is there anything else at all I can help with?
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, just a moment. I have a few questions to ask and they give me a second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] You're welcome and the phone.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, could you please tell me, uh, which CPT code is not covered under the member's plan is 99213. Am I right?
[AGENT][NEUTRAL] The trip.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what will be the time you find to submit the corrected claim?
[AGENT][NEUTRAL] Yeah, there there's no timely filing you can submit it at any time.
[CUSTOMER][NEUTRAL] Where.
[CUSTOMER][NEUTRAL] OK, could you please help me with the mailing address of the correctly?
[AGENT][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] That is in [PII].
[CUSTOMER][POSITIVE] Thank you thank you.
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, the zip code is [PII]. Am I right?
[AGENT][POSITIVE] That is right.
[CUSTOMER][POSITIVE] OK, perfect. Thank you, [PII] and what will be the time defining to submit an appeal?
[AGENT][NEUTRAL] Uh, you can submit an appeal at, uh, it's usually 181 days for an appeal.
[CUSTOMER][NEUTRAL] know
[CUSTOMER][NEUTRAL] 180 days from the denial date or from the process date.
[AGENT][POSITIVE] That is correct. Right, that's right.
[AGENT][NEUTRAL] 42.
[CUSTOMER][NEGATIVE] Um, they denied it.
[AGENT][NEUTRAL] From the Denali, that is correct.
[CUSTOMER][NEUTRAL] OK, and the mailing address for an appeal will be the same?
[AGENT][NEUTRAL] It will be exactly the same.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, thank you. Is there any specific form for an appeal [PII]?
[AGENT][NEUTRAL] No, there's not. You would just send it in as an appeal.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, perfect. And then I will is required for submitting the claim or an app?
[AGENT][NEUTRAL] You would just send in the documents again that that was.
[CUSTOMER][NEUTRAL] Yeah, so the name of supervisor.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] And then that will go to our appeals.
[CUSTOMER][NEUTRAL] Uh, no, I'm, uh, talking about the denied EOB EOB explanation of benefits is required while submitting the claim or IP.
[AGENT][NEGATIVE] No, no, it is not. It is not. You just need to let us know that it was, that it was denied. Yeah.
[CUSTOMER][NEUTRAL] OK, [PII], thank you, perfect. And the call reference number will be your name in today's date. Am I right?
[AGENT][NEUTRAL] So that's fine.
[CUSTOMER][NEUTRAL] OK, perfect. Thank you, [PII], and could you please help me with a few more claims? I have more 3 claims on file.
[AGENT][NEUTRAL] OK, and what is the policy number for the next one, please?
[CUSTOMER][NEUTRAL] Uh yeah, just a moment. My system is thinking. Give me a second.
[CUSTOMER][NEUTRAL] OK, [PII]. Uh, the next policy number will be 02515495.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and the last name is [PII] and the date of birth will be [PII].
[AGENT][NEUTRAL] Thank you. And what date of service are you looking for for sharing?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Is there a particular bill amount that I need to look at?
[CUSTOMER][NEUTRAL] OK so I just went to see uh.
[CUSTOMER][NEUTRAL] Yeah, it's $561.42.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, may I know the time and time next uh next Friday.
[AGENT][NEUTRAL] Just checking
[CUSTOMER][NEUTRAL] So let me go team for what a question which.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So uh you should be calling by [PII] or [PII] or [PII].
[AGENT][NEUTRAL] OK, your claim number on this.
[AGENT][NEUTRAL] It's 35.
[AGENT][NEUTRAL] 7
[AGENT][NEUTRAL] 3580.
[CUSTOMER][NEUTRAL] And [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yeah, I'm looking for an appeal status for this one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] And when did you send in the appeal?
[CUSTOMER][NEUTRAL] We have sent the appeal on [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Excuse me just a moment, I'm right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, it looks like this was sent back to us, um, but it was, uh, it was treated as a duplicate, uh, because there's nothing on here. It does say that the, that the, the CPT codes were, um, they weren't denied. uh, what happened was that the benefits went towards the, uh, deductible of that the, um, policy has a uh deductible on this. Let me just check and see.
[CUSTOMER][NEUTRAL] I want
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] But that is
[AGENT][NEUTRAL] But it wasn't listed as an appeal, [PII], and that's why it wasn't treated as mine, um, that it's, uh, you actually have to kind of, uh, put on there that it's, uh, that it's an appeal. Now I do see where they said that the reconsideration, but, uh, they don't, they just treat that as a duplicate.
[AGENT][NEUTRAL] So, um, let me just see what we have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the appeal has been denied as a duplicate.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, yes, it was denied as a duplicate because it wasn't listed as an appeal. Now, the, the benefits for this, there is a $100 deductible that must be met on this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and that's where the, the benefits went to. So if you wish to, uh-huh.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] So the appeal was not considered as an appeal.
[AGENT][NEUTRAL] Well, it wasn't listed as an appeal. It just said reconsider it because they were denied and you actually have to put the word appeal on there unfortunately it's uh you have to have, you actually have to say, you know, we've sent this in and and you actually have to list it as an appeal so uh um.
[AGENT][NEUTRAL] If you just put for reconsideration or review, it's already been reconsidered, um, and, and the benefits went towards the deductible and the, and the policy doesn't cover, um, uh, an office debit, but if you want someone to explain it to you when, uh, why this won't be paid, um, you would need to send it as an appeal.
[AGENT][NEUTRAL] So you could, you could certainly send it back.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] And they, and they will uh they will be glad to, um, to explain to you again why it's uh what's denied. I, I'm sorry you you cut out, [PII]. I, I didn't hear that.
[CUSTOMER][NEUTRAL] Do not.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And uh [PII], uh, have you received two appeals?
[AGENT][NEUTRAL] No, I, I haven't received any appeal. I received the original claim and then I received something that said reconsideration and review, um, but it was, it was reconsidered and it and it was reviewed.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. So you have
[CUSTOMER][NEUTRAL] So you have not received an appeal. You have received the claim.
[AGENT][NEUTRAL] I've just received the claim twice, yeah.
[CUSTOMER][NEUTRAL] OK. Bear with me just a moment.
[CUSTOMER][NEUTRAL] OK. And the previously and the claim was denied because the office visit does not come under the member's plan, am I right?
[AGENT][NEUTRAL] Yes, that it's the office visits aren't covered under the member's plan.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And, and the second claim is denied as duplicate. Am I right?
[AGENT][NEUTRAL] Yes, that is right, yes. Now, there were 21 of the things I wanted to tell you is that there were 2 procedures, excuse me.
[AGENT][NEUTRAL] There were 2 procedures that were covered.
[CUSTOMER][NEUTRAL] OK. Uh, so [PII]?
[AGENT][NEUTRAL] Yes. Yes, sir.
[CUSTOMER][NEUTRAL] Uh, so, [PII], could you please help me with the duplicate claim first? Could you please tell me the received date, denial date, and the claim number for the duplicate claim?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, the duplicate claim.
[AGENT][NEUTRAL] Uh, that was received on [PII].
[AGENT][NEUTRAL] 2025.
[AGENT][NEUTRAL] And it was processed on [PII].
[AGENT][NEUTRAL] The claim number for that.
[CUSTOMER][NEUTRAL] And process on which day?
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes. It was received on [PII].
[AGENT][NEUTRAL] And 4 days later on [PII], it was processed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim number
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 3, yes, uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim number is 3.
[CUSTOMER][NEUTRAL] Yeah, go ahead, go ahead.
[AGENT][NEUTRAL] The claim number is 357.
[CUSTOMER][NEUTRAL] really.
[AGENT][NEUTRAL] 3580.
[CUSTOMER][NEUTRAL] OK. And what will be the received date, denial date, and the claim number which is denied as office visit is not covered under the member's plan.
[AGENT][NEUTRAL] That was received on [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And that claim number
[AGENT][NEUTRAL] It's 355.
[AGENT][NEUTRAL] 9772.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And which CPT code is not covered under the member's plan?
[AGENT][NEGATIVE] The CPC code that was not covered.
[AGENT][NEUTRAL] It's 99
[AGENT][NEUTRAL] 2
[AGENT][NEUTRAL] 14.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, just a single CPT code.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] That that's the only one that was not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And the further details will be the main same which you gave me before.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, just a moment, and they give me a second.
[CUSTOMER][NEUTRAL] OK. And [PII], could you please tell me what will be the original claim timely filing limit?
[CUSTOMER][NEUTRAL] I'm not.
[AGENT][NEUTRAL] For the appeal?
[CUSTOMER][NEUTRAL] It's but I
[AGENT][NEUTRAL] It will be, it's 100.
[CUSTOMER][NEUTRAL] Uh, no, what will be the original claim.
[CUSTOMER][NEUTRAL] Uh huh
[AGENT][NEUTRAL] The original thing, um.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That would be from uh [PII].
[AGENT][NEUTRAL] [PII], that's the original plan.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm asking about what will be the timely filing limit to submit an original claim. What will be the original claim timely filing limit?
[AGENT][NEUTRAL] It, it, it, it would still be, you know, it would still be 180 days.
[AGENT][NEUTRAL] Just, just as before.
[CUSTOMER][NEUTRAL] From the denial date?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] And is there any specific attention to the appeals?
[AGENT][NEUTRAL] Uh, you would just need to send it to appeal. It actually needs to be sent, it actually needs to be, uh, directed towards appeal and, and you actually have to say that it's an appeal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. And.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] OK. Shall we move to the next screen?
[AGENT][NEUTRAL] Yes, and what is that, um, I'm sorry, what is that policy number?
[CUSTOMER][NEUTRAL] Yeah, just a second, give me a minute.
[CUSTOMER][NEUTRAL] Yeah, uh, the next policy number is 02405412.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is.
[CUSTOMER][NEUTRAL] [PII], uh first name is [PII] and the last name is [PII]. Date of birth will be [PII].
[AGENT][NEUTRAL] Thank you. What is that um uh
[CUSTOMER][NEUTRAL] We have the provider
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Service day.
[CUSTOMER][NEUTRAL] What is looking for right now.
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[CUSTOMER][NEUTRAL] that you.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, [PII]. Yeah, you are right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't have anything for [PII] for [PII].
[CUSTOMER][NEUTRAL] OK, so the claim is not on file for the date of service.
[AGENT][NEUTRAL] No, I, I have one on [PII], is that so?
[CUSTOMER][POSITIVE] OK, perfect. Just a moment.
[AGENT][NEUTRAL] You think that
[AGENT][NEUTRAL] Have you ever build them out for that.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, could you please tell me if the patient active on the data service?
[CUSTOMER][NEUTRAL] It's like
[AGENT][NEUTRAL] Uh, yes, yes, they are, they are active.
[CUSTOMER][NEUTRAL] OK. What will be the policy effective date and the term date?
[AGENT][NEUTRAL] Uh, it's not termed. The policy went into effect on [PII].
[CUSTOMER][NEUTRAL] you'll need.
[AGENT][NEUTRAL] And it is a
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK. Could you please tell me, are you primary or secondary for the member?
[AGENT][NEUTRAL] Uh, let me just check this, well this is the secondary, so let's see what we have for the uh.
[CUSTOMER][NEUTRAL] That's really
[CUSTOMER][NEUTRAL] What.
[AGENT][NEUTRAL] Primary insurance.
[CUSTOMER][NEUTRAL] You be.
[AGENT][NEUTRAL] OK, I show that their primary insurance is called Community Care.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of Oklahoma, so there, so the primary yes.
[CUSTOMER][NEUTRAL] That's uh.
[CUSTOMER][POSITIVE] So, yes, I am I right.
[AGENT][NEUTRAL] Well, we are the secondary insurance, the primary insurance looks like it's community care of Oklahoma.
[CUSTOMER][NEUTRAL] OK. And when was the last coordination of benefits updated?
[AGENT][NEUTRAL] It would have been [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And could you please tell me the, your payer ID, your payer ID?
[AGENT][NEUTRAL] It's 60
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] OK. And the further details will remain the same, the claim submission, timely filing and the mailing address.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. And what will be the preferred mode of submission?
[AGENT][NEUTRAL] Yeah, I'm, I'm sorry, [PII], you, you cut out again. What, um, do you mind telling me that again?
[CUSTOMER][NEUTRAL] It's, what will be the preferred mode of submission?
[AGENT][NEUTRAL] But you can send it mail or or uh or fax. Uh, we have an online service center as well um.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK, perfect. And shall we move to the last claim?
[AGENT][NEUTRAL] Yes,
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] OK. The next member ID is 018.
[CUSTOMER][NEUTRAL] 458 53 M as in Mike, L as in Lima, and S as in [PII].
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and the last name is [PII]. Date of birth will be [PII].
[AGENT][POSITIVE] I appreciate that thank you. Let me just see what we've got here.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Business agreement associates.
[AGENT][NEUTRAL] For [PII]. OK.
[AGENT][NEUTRAL] And what data service are we looking for for now?
[CUSTOMER][NEUTRAL] It's [PII] and the bill amount will be $382 even.
[AGENT][NEUTRAL] Thank you. Um, on this one, [PII], your claim.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Is um 3.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 58.
[AGENT][NEUTRAL] 1281. So again that's 358.
[AGENT][NEUTRAL] 1281.
[AGENT][NEUTRAL] Now, this particular policy, well, let me give you the dates when we received it, OK? Well, I'll give you that first and then we'll go over the benefits. Now, we received this [PII].
[AGENT][NEUTRAL] We processed it on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Now this was an office visit. This is treatment within the physician's office, and this policy, each of these policies are different. This policy only covers in hospitals or outpatient hospital services, so you would actually have to be in a hospital for this policy to work, uh, rather than a physician's office. So this claim 3581281 was denied because the services were rendered within a physician's office.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Now, that's, uh, that is per the patient's plan.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] So it's denied for the same reason because the services are not covered under the member's plan.
[AGENT][POSITIVE] That is right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you wish to file an appeal on this one, it's gonna be exactly the same as the others that we talked about.
[AGENT][NEUTRAL] Um, just be sure please that you that you actually send it as an appeal.
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] OK. And the CPT code will be [PII]. Am I right?
[AGENT][POSITIVE] That is right.
[CUSTOMER][NEUTRAL] This particular CPT code is not, OK, this particular security code is not covered under the member's plan.
[AGENT][POSITIVE] That is right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. And the further details will remain the same, [PII], am I right?
[AGENT][POSITIVE] That is right.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK, and [PII], I do have the last claim on the file. Could you please help me with that? I thought the last, but I have one more.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Yes, and what is that, uh, policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 01611733 M as in Mike, L as in Lima, and the number 8.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please.
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII]. Date of birth will be [PII].
[AGENT][NEUTRAL] Thank you. And what date of service are we looking for for [PII]?
[CUSTOMER][NEUTRAL] And the date of service is [PII].
[AGENT][NEUTRAL] In the building up please.
[CUSTOMER][NEUTRAL] Yeah, the bill amount is $276 even.
[AGENT][NEUTRAL] OK, thank you. Um, it looks like your claim number on this is 36.
[AGENT][NEUTRAL] 00
[AGENT][NEUTRAL] 922.
[AGENT][NEUTRAL] Now we received this claim.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] 2025 and we processed it on [PII]. That was yesterday.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And you're gonna be getting that EOB back and it will say that the claim is denied because this policy does not cover office visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Under the member's plan, am I right?
[AGENT][NEUTRAL] That is right under the member's plan.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEGATIVE] This is not going to be covered.
[CUSTOMER][NEUTRAL] And there is also one CPC code. It's 99214. It's not covered under the member's plan.
[AGENT][POSITIVE] 21, that's right, that's right.
[CUSTOMER][NEUTRAL] Is it right?
[CUSTOMER][NEUTRAL] OK. And the further details will remain the same.
[AGENT][NEUTRAL] They're exactly the same.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, [PII], thanks for your assistance, [PII]. Uh, it was a pleasure talking to you and I hope you have a great day.
[AGENT][POSITIVE] OK well thank you for contacting AP have a good day.