AccountId: 011433970860
ContactId: 6161055b-409b-4a64-809e-1efd52bac375
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 539039 ms
Total Talk Time (AGENT): 191720 ms
Total Talk Time (CUSTOMER): 147529 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/6161055b-409b-4a64-809e-1efd52bac375_20250226T13:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from Massey Hospital looking for a claim status.
[AGENT][NEUTRAL] I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Policy number 01963639.
[AGENT][NEUTRAL] And I'll get phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] extension [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] Yes. Uh [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] [PII]. OK, thank you. Give me one moment to pull up the file.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] [PII], can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK, and you can also check claim status online at [PII]. And what is the date of service and the total bill amount?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The service number 72022 and the bill amount $576 even.
[AGENT][NEUTRAL] [PII] for $576.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the procedure code or codes on the claim, please?
[CUSTOMER][NEUTRAL] Uh, line one procedure.
[CUSTOMER][NEUTRAL] 99204.
[CUSTOMER][NEUTRAL] And uh line 220,610.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this claim was received [PII], processed [PII]. Um, the office visit fee is not covered under this policy, and then for the treatment code, the maximum outpatient benefit is exhausted, so no payment was made on this claim. I'm showing it processed under claim number 3231146. And did you have any other questions, [PII], I could help out with today?
[CUSTOMER][NEUTRAL] No, that's all I have for you. Uh, for my documentation purpose, may I know the time funding limit for appeal?
[AGENT][NEUTRAL] 180 days from the date of the denial.
[CUSTOMER][NEUTRAL] OK. Is it possible to factor UOB?
[AGENT][NEUTRAL] So it's exceeded that time frame.
[AGENT][NEUTRAL] The COB was mailed when the claim was processed and it is now available to download on the online service center. I can help you download that if you would like while we're on this call.
[CUSTOMER][NEUTRAL] Uh, just one.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] The actual problem I have uh here in this portal I have to add multiple tax IDs.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, just, uh, I have multiple tax IDs, uh, that's why I've already created, uh, I already registered for this photo, which.
[CUSTOMER][NEUTRAL] Just someone.
[AGENT][NEUTRAL] So you would just use the tax ID number on your claim and then the patient account number on your claim and it would have to match exactly how we have it in our system so I'll help you go through that let me know when you've logged on to the website.
[CUSTOMER][NEUTRAL] Uh, can you help me how to add the additional tax IDs?
[AGENT][NEUTRAL] You so if it's for a different uh provider you would need to create a new account.
[AGENT][NEUTRAL] If it's a different tax identification number.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] That's a problem because I have around this messy hospital there are 200+ tax IDs.
[AGENT][NEUTRAL] OK, what is the tax identification number on the claim?
[CUSTOMER][NEUTRAL] OK. mm.
[CUSTOMER][NEUTRAL] On this claim, I have tax ID [PII].
[AGENT][NEUTRAL] OK, and have you created an account for that tax identification number before?
[CUSTOMER][NEUTRAL] No, not it.
[CUSTOMER][NEUTRAL] I have to do that then.
[AGENT][NEUTRAL] So then you would just go to [PII].
[CUSTOMER][NEUTRAL] OK, I can create that one. I have 2 more clients. Is that possible to for the claim status?
[AGENT][NEUTRAL] Is it for the same patient?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is the other data of service?
[CUSTOMER][NEUTRAL] For the same tax ID.
[CUSTOMER][NEUTRAL] [PII] and bill amount 184. And you said the office visit is not covered, right?
[AGENT][NEUTRAL] OK, wait a minute. You gave me a different date of service of [PII], and what's the total bills?
[CUSTOMER][NEUTRAL] And the special plan?
[CUSTOMER][NEUTRAL] 184
[AGENT][NEUTRAL] OK, and then you go back to the one we just referenced, the 323-1146 claim number?
[CUSTOMER][NEUTRAL] Yeah, why, why I'm asking this is also offer the zip code, but that's why I'm asking.
[AGENT][NEUTRAL] Are we talking about claim number 3231146?
[CUSTOMER][NEUTRAL] No. All right, just.
[CUSTOMER][NEUTRAL] Just provide me the status for the [PII] claim.
[AGENT][NEUTRAL] OK, so I wrote down, I wrote down [PII]. Is it [PII]?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII], I'm sorry, that's my bad. [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And I thought you were asking about the office visit from the previous claim that was status. Is that correct or not correct?
[CUSTOMER][NEUTRAL] No, please, never mind. Just provide me the status for this claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, give me one moment to document this call and then I'll move to that next policy number, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Verify the patience, um.
[AGENT][NEUTRAL] Name and date of birth on the next.
[AGENT][NEGATIVE] You actually didn't give me a policy number. Is it you said it's for the same person?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So under this claim, the office visit is not covered, so this policy does not cover office visits. The claim number for this date of service is 3289.
[AGENT][NEUTRAL] 304.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you had one more data service?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that data service?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the amount?
[CUSTOMER][NEUTRAL] $184 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the office visit was denied. Um, the claim number for this one is 337.
[AGENT][NEUTRAL] 3062.
[CUSTOMER][NEUTRAL] May I have the denial date?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Received [PII].
[AGENT][NEUTRAL] Process which would be the denial date [PII].
[CUSTOMER][NEUTRAL] Mhm. Yes, yes.
[CUSTOMER][NEUTRAL] OK, is there a call reference number for this call?
[AGENT][NEUTRAL] My name in today's date, [PII], first initial last name is [PII]. Any other questions, [PII], I can help with today?
[CUSTOMER][POSITIVE] That's all for you. Thank you so much again. Have a wonderful day. Bye.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thank you. You too.