AccountId: 011433970860
ContactId: 2fcdf316-67a6-4728-aa25-c279cffcb7be
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1068140 ms
Total Talk Time (AGENT): 180238 ms
Total Talk Time (CUSTOMER): 287415 ms
Interruptions: 4
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/2fcdf316-67a6-4728-aa25-c279cffcb7be_20250514T13:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, [PII]. The side kite calling from provider's office looking to discuss about a claim. Can you please help me on this?
[AGENT][NEUTRAL] Yes, I can help with claim status. Um, I missed your name. What was that?
[CUSTOMER][NEUTRAL] Yeah, I look like
[CUSTOMER][NEUTRAL] Kite Kilo India Tom [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. And then do you have the policy number for that patient?
[CUSTOMER][NEUTRAL] 02353231.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Is [PII] [PII].
[AGENT][NEUTRAL] And you have the date of service and bill charges?
[CUSTOMER][NEUTRAL] [PII] for the bill charge 1,477.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] OK, it looks like we received the claim on
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 128 25. 0, it's processed on 130 2025.
[AGENT][NEUTRAL] And we're needing a copy of the primary explanation of benefits.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I do not have any uh primary insurance information on my end. This is the APL is the only insurance which I have on file. Uh uh by chance you have if you have any uh information on uh primary uh insurance.
[AGENT][NEUTRAL] Uh, yes, let me check. And then do you have a good callback number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Uh, looks like we've got Aetna as their primary insurance.
[CUSTOMER][NEUTRAL] Looks like we've
[CUSTOMER][NEUTRAL] As their
[CUSTOMER][NEUTRAL] Uh, do you have their, uh.
[AGENT][NEUTRAL] I don't have their member ID.
[CUSTOMER][NEUTRAL] OK, when, from when to when, um, OK, from when the insurance was active [PII] I mean as primary.
[AGENT][NEUTRAL] Uh, it looks like it started [PII].
[CUSTOMER][NEUTRAL] OK, um
[CUSTOMER][NEUTRAL] Still active, right? So, uh,
[AGENT][NEUTRAL] I'm not sure you'd have to contact Aetna.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so you're stating that APL is secondary, uh, insurance for this is, uh, right, [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK. Could you please help me with the call reference, uh, and your last initial starting?
[AGENT][NEUTRAL] Uh, the call reference is my name, [PII], and then today's date.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] Missing primary will be OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] APL
[AGENT][NEUTRAL] Is there anything else I can help with today?
[CUSTOMER][NEUTRAL] Um, just checking on my end if I have any other, um.
[CUSTOMER][NEUTRAL] Um, the patient for this plan.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for your patience.
[CUSTOMER][NEUTRAL] It's for APL, right?
[AGENT][POSITIVE] Yes, that's right.
[CUSTOMER][POSITIVE] Yes that's right.
[CUSTOMER][NEUTRAL] Uh, [PII], OK, uh, let's move ahead with another patient.
[AGENT][NEUTRAL] OK, you have the policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 002-215-284.
[AGENT][NEUTRAL] The patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK. Could you give me that policy number one more time? I pulled up a different name.
[CUSTOMER][NEUTRAL] 002-215-284.
[AGENT][NEUTRAL] Uh, yeah, it's pulling up a different name. Let me try the name. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm trying to locate uh if she's in our system.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you have her date of birth?
[CUSTOMER][NEUTRAL] Um, date of birth is [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Date of service and bill charges.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII] 2024 for the bill charge of
[CUSTOMER][NEUTRAL] 1,232.30 cents.
[AGENT][NEUTRAL] Uh, it was received on [PII]. Process 114-2025.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And it was denied as uh services covered after termination date.
[CUSTOMER][NEUTRAL] It was.
[AGENT][NEUTRAL] Services are not covered. So she termed, her policy terminated [PII].
[CUSTOMER][NEUTRAL] Mm, [PII].
[CUSTOMER][NEUTRAL] Policy was turned on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII]. OK. And uh do you have any other information for this patient? Any other insurance?
[AGENT][NEUTRAL] Uh, no, I don't.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Could you please help me with the claim number?
[AGENT][NEUTRAL] Same number 3551694.
[CUSTOMER][NEUTRAL] I do have 3551692 on my end.
[AGENT][POSITIVE] OK, yes, sorry, that, that's good.
[CUSTOMER][NEUTRAL] OK, yeah, sorry.
[CUSTOMER][POSITIVE] All right, thank you so much for your help. Let's move ahead with another patient.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah. 02351181.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Data service and bill charges.
[CUSTOMER][NEUTRAL] [PII] of [PII].
[CUSTOMER][NEUTRAL] For the charged amount 1,513.
[AGENT][NEUTRAL] Um, what was the
[CUSTOMER][NEUTRAL] Um what was the?
[AGENT][NEUTRAL] Healthcare provider on that?
[CUSTOMER][NEUTRAL] Health
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Prisma Health Oakan Memorial Hospital.
[AGENT][NEUTRAL] Um, can you see the procedure code?
[CUSTOMER][NEUTRAL] Um, procedure code is.
[CUSTOMER][NEUTRAL] 0241 U. 99283.
[AGENT][NEUTRAL] Uh, received 311-2025 process 3-17-2025.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Uh, looks like this policy does not cover this place of service. Service is only allowed in outpatient hospital or physician's office.
[CUSTOMER][NEUTRAL] Does that
[CUSTOMER][NEUTRAL] Services only.
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] OK, the plan does not cover this, uh, what is the plan name, uh, which the uh uh patient have?
[AGENT][NEUTRAL] HI 17, B as in boy.
[CUSTOMER][NEUTRAL] HI 7B. This is the plan name for this patient.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So you're stating that the CPT codes uh which we have billed uh it's non-covered for this.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, CPT code 0 0241U and 99283, but another one which we have built, it's laboratory laboratory, no, it's laboratories, uh.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's for laboratory and another one CPT code, it's emergency. However, the another code is 0241U. It's laboratory.
[AGENT][NEUTRAL] But are, are you asking about a different claim or what are you?
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] You know, uh, the same claim which you have submitted, um, and the CPT code, uh, we have billed is two CPT codes now. One is 0241U and another CPT code is 99283.
[AGENT][NEUTRAL] All we have is 99283.
[AGENT][NEUTRAL] That's all that was received.
[CUSTOMER][NEUTRAL] Uh, can you please reprocess this claim once as, uh, we have, um, billed this, uh, with, uh, CPT two CPT codes.
[AGENT][NEUTRAL] I'll pull up the claim, but we only received one code, so you'll have to resubmit the claim.
[CUSTOMER][NEUTRAL] To claim but we only received one kind of.
[AGENT][NEUTRAL] Can you resubmit the claim with the other code?
[AGENT][NEUTRAL] Are you there?
[CUSTOMER][NEUTRAL] Mhm. Sure. Uh, help me with the correct, uh, the timely filing to submit with the corrected claim and
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Timely filing to submit with the corrected claim and corrected claim address.
[AGENT][NEGATIVE] Uh, there's no timely filing, and the address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Um, [PII]. Perfect.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 895-0731248950.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And help me with the claim number as well.
[AGENT][NEUTRAL] 3576693
[AGENT][NEUTRAL] Did you have another claim, or?
[CUSTOMER][NEUTRAL] I'm just checking on my I for have.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] No, thank you so much for your help, [PII].
[AGENT][POSITIVE] OK, thank you for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] All right you too as well bye bye.
[AGENT][POSITIVE] Thank you. Bye bye