AccountId: 011433970860
ContactId: 33bf6210-4862-4d4a-b95e-33a82611941c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 297700 ms
Total Talk Time (AGENT): 139093 ms
Total Talk Time (CUSTOMER): 77627 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/33bf6210-4862-4d4a-b95e-33a82611941c_20250122T16:03_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hey, hi, this is [PII] calling from the doctor's office.
[AGENT][NEUTRAL] Hi, [PII], and how can I help you, my friend?
[CUSTOMER][NEUTRAL] Yes, I'm looking for uh claim denial clarifications.
[AGENT][NEUTRAL] OK, yeah, I can help you look at that claim denial today and.
[AGENT][NEUTRAL] Do you mind if I get a good call back number please?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you and the policy number we want to look at?
[CUSTOMER][NEUTRAL] Yes, uh, the policy number is.
[CUSTOMER][NEUTRAL] So it's 023-37756 M as in Mike.
[CUSTOMER][NEUTRAL] I as in India 8.
[AGENT][POSITIVE] Thank you. I appreciate that and give me one moment to pull everything up for you.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] All right. Would you be able to verify for me, pretty please, your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, yeah, the uh patient name is it's uh.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date of birth year is, it's uh [PII].
[AGENT][POSITIVE] Perfect. I do see that here. And do you have a claim number in particular you want me to look at with you?
[CUSTOMER][NEUTRAL] Yes, uh, the claim number is, it's uh 3,541,600.
[AGENT][NEUTRAL] 3,541,600
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And could you just verify for me the name of the facility on file for this claim?
[CUSTOMER][NEUTRAL] Yes, uh, the name of the facility is Advanced Pain Management.
[AGENT][NEUTRAL] OK, perfect. Thank you so much. Um, so I do see that claim. It looks like um it has two different denial codes on it. The first one is going to be for that procedure code, the 99213, and that denial code is just stating that office visits are not covered by the above numbered policy.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And then the next denial code is the same for all of the rest of the procedure codes on the claim, and it just states that the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yes, uh, so can you repeat one more time for the 99213 for the documentation purpose.
[AGENT][NEUTRAL] Oh, yes, for that one, it states that office visits are not covered by the above numbered policy.
[CUSTOMER][NEUTRAL] OK fine so.
[CUSTOMER][POSITIVE] OK, uh thank you for that and uh.
[CUSTOMER][NEUTRAL] So, uh, may I know the appeal mailing address?
[AGENT][NEUTRAL] Yeah, absolutely, um, so the appeals mailing address is the same as our claims mailing address, but you'll just address the envelope to APL appeals department, and that is going to be the [PII].
[AGENT][NEUTRAL] And then our zip code is [PII].
[CUSTOMER][NEUTRAL] OK, and thank you for that. And uh may I know the fax number?
[AGENT][NEUTRAL] Yes, our fax number is [PII].
[CUSTOMER][NEUTRAL] OK. Uh, may I know the appeal attentions?
[AGENT][NEUTRAL] Um, you would just make it attention to appeal.
[AGENT][NEUTRAL] Department.
[CUSTOMER][NEUTRAL] OK, and what is the timely filing limit?
[AGENT][NEGATIVE] We don't have a timely filing limit.
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] But you do have 180 days from.
[AGENT][NEUTRAL] [PII] to make an appeal if you do choose to appeal.
[CUSTOMER][NEUTRAL] So from the processing date, right?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] So again thank you for that.
[CUSTOMER][NEUTRAL] Mm OK and uh.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] May I know the call reference number on your good name spelling?
[AGENT][NEUTRAL] Yes, yeah, my name is [PII] First initial last name is [PII] like [PII], and then the reference number is my name, my last initial, and today's date.
[CUSTOMER][POSITIVE] Yes, we can, uh, thank you, [PII], for your kind assistance.
[AGENT][POSITIVE] Oh, it's my pleasure. Thank you so much, [PII], and you have such a wonderful day.
[CUSTOMER][NEUTRAL] Mhm. Have you too bye bye.
[AGENT][NEUTRAL] Bye bye.