AccountId: 011433970860
ContactId: 3ffbaa41-c3cc-4faa-93e8-146d21b9b712
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 385950 ms
Total Talk Time (AGENT): 165291 ms
Total Talk Time (CUSTOMER): 156242 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/3ffbaa41-c3cc-4faa-93e8-146d21b9b712_20250206T13:48_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Thanks, sir. Good morning. My name is [PII] and last initial [PII], calling from office nearestine Institute looking for claim status.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you. What is the callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Policy number is 09.
[CUSTOMER][NEUTRAL] Sorry, the policy number is 019.
[CUSTOMER][NEUTRAL] 89473 M. like Mike L like Lima 8.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] First name is [PII], last name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you, and it would be my pleasure to assist you with that claim status. [PII], do you have a claim number or date of service?
[CUSTOMER][NEUTRAL] Uh, the date of service is [PII]. The bill amount is $1,512.
[CUSTOMER][NEUTRAL] And 70 cents uh I don't have the claim number.
[AGENT][NEUTRAL] That's fine, thank you. And what is the facility name?
[CUSTOMER][NEUTRAL] Uh, first name is American Public Life Insurance.
[AGENT][NEUTRAL] What's the provider name? I'm sorry for the facility name for the provider.
[CUSTOMER][NEUTRAL] Yes, facility, facility name is Neurospine Institute LLC.
[AGENT][NEUTRAL] Alright, thank you, [PII], we did receive that claim on [PII], I'm sorry, [PII].
[CUSTOMER][NEUTRAL] [PII]. OK?
[AGENT][NEUTRAL] Yes sir, and it was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Uh, what is that reason?
[AGENT][NEUTRAL] The 99213 was denied as office visits are not covered for the patient's plan.
[AGENT][NEUTRAL] And the
[CUSTOMER][NEUTRAL] Uh, sorry, uh, which code?
[AGENT][NEUTRAL] The 99213.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the 20,550 was denied as services are not covered when performed in a doctor's office.
[CUSTOMER][NEUTRAL] Uh, actually, uh, primary already paid this claim. The primary insurance is.
[CUSTOMER][NEUTRAL] Um, I wait a moment opening. Let me check.
[CUSTOMER][NEUTRAL] Yes, the United Healthcare is a primary insurance, uh, under this patient. Uh, United Healthcare is the paid, uh, this claim is paid.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, wait a moment.
[CUSTOMER][NEUTRAL] Yes, the paid amount is uh
[CUSTOMER][NEUTRAL] $65
[CUSTOMER][NEUTRAL] As detective board process.
[CUSTOMER][NEUTRAL] And for this procedure code is 20,550.
[CUSTOMER][NEUTRAL] And the detectable process as the patient uh life uh security insurance is American Public Life Insurance Company.
[AGENT][NEUTRAL] Mhm. Yes, sir.
[CUSTOMER][NEUTRAL] Uh, if, uh, yes, if primary process correctly not denied any, uh, and how can denied the secondary.
[AGENT][NEGATIVE] It is not covered per the patient's plan.
[AGENT][NEUTRAL] It's not a covered benefit under the patient's plan.
[CUSTOMER][NEUTRAL] Procedure code is 20,550 not covered under patient plan.
[AGENT][NEUTRAL] That's correct. So that, that procedure is not covered when it's performed in a doctor's office.
[AGENT][NEUTRAL] So due to the place of service.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEGATIVE] That procedure is not covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, sorry, uh, 22, 20,550 is not covered under the patient plan and then
[CUSTOMER][NEUTRAL] What is the line?
[AGENT][NEUTRAL] Because it was performed in a doctor's office. So the place of service for that procedure is not a covered place of service for procedure 20,550.
[CUSTOMER][NEUTRAL] Because the forms from doctor office provider office.
[AGENT][NEUTRAL] That's right. That's correct. No services are covered in a doctor's office, and that's for the patient's plan.
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] No cover, uh, yes, uh, because the performance from provider office, no services, uh, from office.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] A place of service. OK. And uh
[CUSTOMER][POSITIVE] OK, thank you so much and uh.
[AGENT][NEUTRAL] Did you want that claim number?
[CUSTOMER][NEUTRAL] Please
[CUSTOMER][NEUTRAL] Uh, yes, give me.
[AGENT][NEUTRAL] Sure. [PII], that claim number is 355.
[AGENT][NEUTRAL] 1119.
[CUSTOMER][NEUTRAL] 355-1119 it's claim number.
[AGENT][NEUTRAL] Yes, sir that is correct. Mhm, that's the claim number.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] Yeah, OK, thank you so much. Uh, please verify your name and if you send the, the, uh, UOB, the denial letter or fax number.
[AGENT][NEUTRAL] Mhm. EOBs are obtainable on our provider portal at secured. That's [PII], and that is a simple self registration using the tax ID number and the patient's account number inbox 26 on the HC file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And uh please uh verify your name spelling.
[AGENT][NEUTRAL] Sure. My name is [PII], if you need a reference number, it would be my name and today's date.
[CUSTOMER][NEUTRAL] OK, today is it.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] OK, sure, thanks. Uh, OK, [PII], thanks you and have a lovely day. Bye-bye.
[AGENT][POSITIVE] I hope you have a wonderful day as well, [PII]. If there's nothing else I can assist you with, thank you for calling APL and take care.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.