AccountId: 011433970860
ContactId: 58dd9a5d-1c05-48d9-be5c-8080131a9514
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 490260 ms
Total Talk Time (AGENT): 138393 ms
Total Talk Time (CUSTOMER): 156121 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/58dd9a5d-1c05-48d9-be5c-8080131a9514_20250530T13:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. How are you? My name is [PII].
[AGENT][POSITIVE] I'm good, [PII]. How can I help today?
[CUSTOMER][NEUTRAL] I'm calling to check the status of a claim, please.
[AGENT][POSITIVE] All right. Happy to check on a claim. Do we have a policy number?
[CUSTOMER][NEUTRAL] Yes, 02283218.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII] was 1.
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then the build out.
[CUSTOMER][NEUTRAL] I don't have that, but I know it was for um let me give you the codes.
[CUSTOMER][NEUTRAL] 01200274 and 8680.
[AGENT][NEUTRAL] All right, one moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, and the codes were 868-00274 and 0120?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Did you guys receive it?
[AGENT][NEGATIVE] So there was a claim received. It states that it was a duplicate claim. So then I went to try and find um the other claim for 319 of 25. I don't see any other claims for 319 of 25. However, code 8680 was submitted twice. The plan itself doesn't have any ortho coverage, so it was denied.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, but still we need an EOB for that. But then the other two, which is the periodic exam and the by wings.
[CUSTOMER][NEUTRAL] What happened?
[AGENT][NEUTRAL] So that was processed as the duplicate. I can send you the EOB. Do you have a fax number?
[CUSTOMER][NEUTRAL] OK, but yes, but duplicate of what because we didn't submit it before like that's the only time we send it.
[CUSTOMER][NEUTRAL] Because before that, the previous periodic exam was in September.
[CUSTOMER][NEUTRAL] So it cannot be a duplicate.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So I can submit this um to be looked at again [PII] because I don't know if when I search procedure code 0120, the date of service prior to 3-19 I do see is 94-24.
[CUSTOMER][NEUTRAL] Yes, 319 of 20, OK, 319 of 2024 you said was received when?
[AGENT][NEUTRAL] Let me give you the received date. Bear with me one moment, please.
[CUSTOMER][NEUTRAL] Oh no, no, no, I thought I was just saying that. I'm sorry, what was it that you were saying then about the 319?
[AGENT][NEUTRAL] I can put it in to be looked at again cause I don't know why the other two codes are reading as a duplicate claim cause I don't see another claim for that date of service for that specific procedure code. The only duplicate I see is the ortho the ortho treatment that was sent.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Which is not duplicate, but yeah, I understand what you're saying.
[CUSTOMER][NEUTRAL] And it's still it's not duplicate because the first one in [PII] was the lower arch and the one on [PII] was the upper arch so it's not duplicate anyways but uh so you're gonna send it again to for review.
[AGENT][NEUTRAL] Right, I'll resend it for review, yeah.
[CUSTOMER][NEUTRAL] She's gonna send it again to review because it sounds like a duplicate, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, so, um, how long do we have to wait for this, uh, to be resent and review again?
[AGENT][NEUTRAL] Um, I would give it at least 5 business days to check back on it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, may I please have a reference number for this call?
[AGENT][NEUTRAL] It's my name with today's date. My name is [PII], that's [PII] Last initial is [PII] and then today's date.
[CUSTOMER][NEUTRAL] OK. [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] T as in tomato 53025.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK, so, um, in the meantime they're gonna reprocess and review the, uh, re-review the, uh, the two codes for the 01200274. Can we get the EOB for the or interpretation so we can take that out of the equation?
[AGENT][NEUTRAL] Yeah, what's the fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Just to confirm, 941.
[CUSTOMER][NEUTRAL] And if you can, uh-huh.
[AGENT][NEUTRAL] [PII], correct?
[CUSTOMER][POSITIVE] Correct, mhm.
[CUSTOMER][NEUTRAL] And then can you also send it via email just in case the fax doesn't come?
[AGENT][NEGATIVE] We're not able to send them on email. It's not secure. I can only fax. Would you like me to put attention to anybody on it?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's fine, no problem.
[CUSTOMER][POSITIVE] Um, no, I'm the only one to receive it here, so don't worry, I just hope it comes soon.
[AGENT][NEUTRAL] OK, give it about 5 minutes, [PII], OK?
[CUSTOMER][POSITIVE] Alright thank you so much sir I really appreciate your help. All right, have a wonderful day bye bye.
[AGENT][NEUTRAL] Yup.
[AGENT][POSITIVE] You're welcome. Have a good day.
[AGENT][NEUTRAL] Bye.