AccountId: 011433970860
ContactId: 3188f30a-43c6-43f3-8b42-b49a1445933a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 778809 ms
Total Talk Time (AGENT): 232381 ms
Total Talk Time (CUSTOMER): 243458 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/3188f30a-43c6-43f3-8b42-b49a1445933a_20250613T13:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Sorry, your call was cutting in and out. Hi, hello?
[AGENT][POSITIVE] Yes, how may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. My last name which is [PII]. I'm calling on behalf of the provider. I do have two claims. My best callback number is [PII].
[AGENT][NEUTRAL] [PII], may I have a policy number?
[CUSTOMER][NEUTRAL] And in case if, if the call is
[CUSTOMER][NEUTRAL] Sure. The policy number is 2002464113.
[AGENT][NEUTRAL] I'm sorry, [PII], can you please repeat the policy number?
[CUSTOMER][NEUTRAL] 02464113
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] Day service.
[CUSTOMER][NEUTRAL] And the date of service, it's.
[CUSTOMER][NEUTRAL] [PII] for the buildup amount.
[CUSTOMER][NEUTRAL] $35 even.
[AGENT][NEUTRAL] That was 310 of 25?
[CUSTOMER][NEUTRAL] Yes, [PII] of [PII].
[AGENT][NEUTRAL] Thank you for future reference, you may visit our website at [PII], get claim status as well.
[AGENT][NEUTRAL] This processed under claim number 3586418 is denied for eligibility.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEGATIVE] This claim processed and denied on.
[AGENT][NEUTRAL] 48 of 25.
[CUSTOMER][NEUTRAL] Uh, eligibility in the sense of whether the member is uh inactive for the doors.
[AGENT][NEUTRAL] That is correct. It looks like the plan termed on 8-25-2024, and there is no active coverage on file.
[CUSTOMER][NEUTRAL] So, coverage has terminated. Can I have the
[CUSTOMER][NEUTRAL] I mean, can I have the reference number for this claim? And also, I do have uh several data service for this same patient that is, could you please help me with that too?
[AGENT][NEUTRAL] Correct. What's the next day of service?
[CUSTOMER][NEUTRAL] [PII] [PII] for the build amount, $175 even.
[AGENT][NEUTRAL] This one processed under claim number?
[AGENT][NEUTRAL] 3591559 is denied for eligibility.
[AGENT][NEGATIVE] This one processed and denied on [PII].
[CUSTOMER][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] Thank you. And the next date of service is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, [PII] for the bill amount, $35 even.
[AGENT][NEGATIVE] OK. And as of today, that one is not received.
[CUSTOMER][NEUTRAL] But we have received an UP.
[AGENT][NEUTRAL] May I have that claim number?
[CUSTOMER][NEUTRAL] Stating that is 3591564.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] OK, that one does not match. It's a whole different data service.
[AGENT][NEUTRAL] That one has a different data service.
[CUSTOMER][NEUTRAL] So that one does not manage.
[CUSTOMER][NEUTRAL] So this is no claim on file.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the next date of service is [PII] for the bill amount $65 even.
[AGENT][NEUTRAL] 65.
[CUSTOMER][NEUTRAL] Yes, 65.
[AGENT][NEUTRAL] OK, so this one processed under claim number 3591557, denied for eligibility. This one processed and denied on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much. So, uh, I do have other patients. Could you please help me with that too?
[AGENT][NEUTRAL] One moment. I need to complete this one out. I'll place you on a brief hold. One moment.
[CUSTOMER][NEUTRAL] Sure. You are on hold. It's.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, could you please tell me the reference number of this claim?
[AGENT][NEUTRAL] Yes, it will be my name, which is [PII] Last initial is [PII] along with today's date.
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] May I have the next policy number?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes, I'm OK. The next policy number is 02266763.
[AGENT][NEUTRAL] And that is 02266763.
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And her date of birth?
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. May I have a date of service?
[CUSTOMER][NEUTRAL] And the date of service is [PII] for the bill amount.
[CUSTOMER][NEUTRAL] 1280. That is $1280 even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And what is the CPT code bill for that?
[CUSTOMER][NEUTRAL] Date of service is 45378 and 4243235.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like this processed under claim number.
[AGENT][NEUTRAL] 3572401.
[AGENT][NEUTRAL] And it looks like on line 45378, it allowed a benefit amount of $250.
[AGENT][NEGATIVE] For the next line, 43235, no benefits were payable.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Um, I'm sorry. Um, upon checking in my system, I have received an EOB that 43235 has been paid for $250 and 45378 for the bill amount $730 it is not paid. And we have received an EOB stating.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Exceed maximum number of hours and hours, day or units exceeded. We have submitted to coding and we found that we have built only one unit.
[CUSTOMER][NEUTRAL] And we have um co has responded to inquire to the insurance for more details.
[AGENT][NEUTRAL] OK, so in our system, the benefit paid on 45378, it paid the benefit amount of $250.
[AGENT][NEUTRAL] And the maximum was exhausted with that payment.
[AGENT][NEUTRAL] And then on the
[AGENT][NEUTRAL] 43235 line.
[AGENT][NEUTRAL] Only the largest surgical procedure is payable. So nothing was paid on that line. You have 180 days to submit an appeal.
[CUSTOMER][NEUTRAL] 180 days for an appeal.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] What about this, what about uh submitting and correct claim?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, submitting for submitting and corrected claim, uh, what is the time you finally limit?
[AGENT][NEUTRAL] There's no time limit to submit a claim or correct the claim, but for to appeal this claim, you have 180 days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. So, uh, could you please repeat the delivery for 43235? It is non-covered or non-resposable as well?
[AGENT][NEUTRAL] One moment, let me go back over here.
[AGENT][NEUTRAL] The largest payable surgical procedure is payable when 2 or more procedures are performed at the same time.
[AGENT][NEUTRAL] So, because 2 were performed at the same time, they only allow benefits for the largest one.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] It should be on that EOB.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Sure. OK. I got it. So, the largest payable is for 45378. So, the 43235 has been denied. Is that correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Is there another data service for [PII]?
[CUSTOMER][NEUTRAL] Um, there is no uh uh
[CUSTOMER][NEUTRAL] No, we don't have any data of service for [PII] on that date.
[AGENT][NEUTRAL] Is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um, no, thank you.
[AGENT][POSITIVE] You are so welcome. And thank you for calling American Public Life. Have a great day, [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Have a great day. Bye-bye.