AccountId: 011433970860
ContactId: 419e92cb-eb17-4046-94f2-f7236e31ee43
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 710409 ms
Total Talk Time (AGENT): 282967 ms
Total Talk Time (CUSTOMER): 279298 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/419e92cb-eb17-4046-94f2-f7236e31ee43_20250121T23:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling for Orange Care Physician Partners of Florida. And please be informed this call is being monitored and recorded for quality and training purposes. I check on the time status. Could you please help me with that?
[AGENT][NEUTRAL] Yeah, I can check on a claim for you [PII]. Uh, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, that's [PII].
[AGENT][NEUTRAL] Alright, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, I have the policy number. The policy number we have uh 02137900 ML 8.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, uh, the patient name [PII]. They is on [PII].
[AGENT][NEUTRAL] Alright, thank you for verifying that [PII] uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Yes, the data service was on [PII] for the amount of $300.01.
[AGENT][NEUTRAL] OK, that was [PII] for $300.01.
[CUSTOMER][POSITIVE] Yes, you are right.
[AGENT][POSITIVE] OK, got it, thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so I did find this claim, [PII]. I appreciate your patience. So looks like there were a couple of line items, uh, the first.
[AGENT][NEUTRAL] Is not I think that's just that penny give me just a moment actually yeah so for the $3 and there's one for the 1 cent, uh, so the procedure code 99213 is the office visit we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh this is uh offices is co-pay or uh
[AGENT][NEUTRAL] The procedure code that's the $300 yeah, office visits are just not covered under this policy, so that's why we were unable to pay that, yeah.
[CUSTOMER][NEUTRAL] Is it offices cooking?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Got it. So after the got it. So as for the patient's policy, this is an office visit. It will not be covered, is it non for as for that patient's policy, got it. O is not. May I know when the claim policy? OK. May I know when the claim is received or when you get paid when you get passes, please.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] It's not covered under their policy, yes.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, we received this claim [PII].
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] So [PII] and you said that the CPT is non-covered as for the business policy here. Perfect thank you uh for that you said perfect. And uh by chance do you have any appeals mailing address?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Do you have any appeals mailing address?
[AGENT][NEUTRAL] Yeah, our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII]?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] And then did you want that
[CUSTOMER][NEUTRAL] So it's an app.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah, that's our mailing address um did you need that claim number, [PII]?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, it is 351-813-9.
[CUSTOMER][NEUTRAL] But is there any timely filing limit for an appeal would be?
[AGENT][NEUTRAL] Yes, there is, uh, it's 180 days from the process date, so it would be 180 days uh from [PII] of last year.
[CUSTOMER][NEUTRAL] About [PII]. OK, thank you. Thank you very much for and the call reference number for this particular claim, please.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date and so my name is spelled [PII] and was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And I still do have 2 more clients with me, so is it possible to help me with that 2 more?
[AGENT][NEUTRAL] Uh, is this gonna be for the same member or for different members?
[CUSTOMER][NEUTRAL] And that is a different member and that is on a different provider as well.
[AGENT][NEUTRAL] OK, all right, yes, give me just a moment I'll let you know when I'm ready for those.
[CUSTOMER][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I am ready for that next policy number.
[CUSTOMER][NEUTRAL] Yes, the next policy number we have 01770235ML8.
[AGENT][NEUTRAL] All right, thank you and uh the name and date of birth for this insured?
[CUSTOMER][NEUTRAL] Yes, uh, the patient's name is [PII] and the date of the [PII].
[AGENT][NEUTRAL] Alright, thank you for verifying that and then uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII] for the amount of $660 for cents.
[CUSTOMER][NEUTRAL] 660.04.
[AGENT][NEUTRAL] $650.04?
[CUSTOMER][NEUTRAL] Uh, that's 660.04.
[AGENT][NEUTRAL] 660. OK, got you, thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And in this claim, I do have a question here.
[AGENT][NEUTRAL] OK, let me find it really quick.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh, what was the name of this, uh, provider, [PII]?
[CUSTOMER][NEUTRAL] Yes, um, this is on Bocaca, I think. Let me go and check that, but it's Bocaca INC.
[AGENT][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] All right, thank you for verifying that. Do you believe I found this claim?
[AGENT][NEUTRAL] Looks like we paid a benefit of $6.45. Give me just a moment, let me take a look.
[AGENT][NEUTRAL] OK, so this one also had an office visit and that's not covered under this policy?
[CUSTOMER][NEUTRAL] Um, I just need to know about the only procedure code, uh, that is, let me go ahead and check the procedure for what it was.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, let me get that here.
[CUSTOMER][NEUTRAL] Uh, the procedure code 9921425. I'm just looking for that particular procedure code.
[AGENT][NEUTRAL] Right, yes, so that one is the office visit and we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Got it. So this is for office visit and that will not be covered as for the patient's policy here as well is it, right? Perfect, thank you. And may I know when the claim was received and when you get passes, please?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Absolutely, so we've received this claim [PII].
[AGENT][NEUTRAL] And then it was processed [PII].
[CUSTOMER][NEUTRAL] [PII] as a non-co as for the patient's policy here and uh uh CPP is non-covered. Perfect, thank you. And the appeals mailing address and the timely filing all would be the same here is it right to accept the claim number.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's correct, um, same address and then 180 days of the process date. Um, did you need this claim number as well?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] It is 34.
[AGENT][NEUTRAL] 77908.
[CUSTOMER][POSITIVE] Perfect. And uh there's no claim, is it, right? This is the only claim first data service.
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] This is the only claim for this the service. There's no other claims received here, is it?
[AGENT][NEUTRAL] Right, that's correct. This was the only claim for that data service.
[CUSTOMER][NEUTRAL] OK, thank you. And may I get the reference number for this one, please?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A reference number is gonna be the same for all of them, um, my first name, last initial and today's date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Got it, got it. Thank you. And [PII] is the last question on this on here.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Yes, one moment please I'll let you know when I'm ready.
[CUSTOMER][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] OK, I'm ready for that last one.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And uh the last member ID is it right? uh or was the
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The member ID I have 1457171.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] Yes, uh, the patient's name, I have [PII]. There the on [PII].
[AGENT][POSITIVE] Alright, yes, perfect, thank you and then uh what was the date of service for this one?
[CUSTOMER][NEUTRAL] It's [PII]. And for the amount of, let me go and get the the the amount on this claim here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's $480 even, $482 even.
[AGENT][NEUTRAL] I'm sorry, that was 482.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. All right, one moment.
[CUSTOMER][NEUTRAL] Meanwhile, let me go ahead and pull the claim image here. What exactly is with.
[CUSTOMER][NEUTRAL] I'm so sorry. I think the total bill amount on the claim would be $331 as for the time we made.
[AGENT][NEUTRAL] OK, yes, I did find it, um, and that's what I was just about to ask if that was the amount after major medical paid. OK, and this was, uh, was it Omni Medical Group?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, perfect. Alright, so yes, this one is going to be the same as the others uh we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Got it. So, may I know when the claim of get passed, please?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] 2, OK, we received this claim [PII], and it was processed [PII].
[CUSTOMER][NEUTRAL] Number 12 of 24 as that the office visit will not be covered by the patient's policy and the CPT is a non-office visit. Thank you. And the, all the information will be the same except the claim number. So may I get the claim number for this one, please?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] Yes, claim number is 352-863-2.
[CUSTOMER][POSITIVE] Perfect, thank you. And for this data service, this is only claim, is it right? There is no other claim received.
[AGENT][NEUTRAL] Correct, this is the only claim we have for the state of service.
[CUSTOMER][POSITIVE] OK fine. And the reference number would be the same. Thank you. Thank you very much for this time. Have a wonderful day. Thank you. Thank you.
[AGENT][NEUTRAL] Yes sir.
[AGENT][POSITIVE] Yeah, yeah, thanks for giving us a call, [PII]. You too. Bye bye.
[CUSTOMER][NEUTRAL] Yeah. Bye-bye. Bye-bye. Bye-bye.