AccountId: 011433970860
ContactId: 63e740b2-ea8d-4e74-b85e-e4da1036a614
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 488130 ms
Total Talk Time (AGENT): 107151 ms
Total Talk Time (CUSTOMER): 148113 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/63e740b2-ea8d-4e74-b85e-e4da1036a614_20250425T13:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. Last name first [PII], calling from provider office to check on claim status.
[AGENT][NEUTRAL] Hey [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Uh, the callback number is [PII].
[CUSTOMER][NEUTRAL] [PII] it's a direct line.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You have the policy number of the patient?
[CUSTOMER][NEUTRAL] Uh yeah.
[CUSTOMER][NEUTRAL] The policy number of the patient is 0221.
[CUSTOMER][NEUTRAL] 2366 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And what was the date of service and bill charges?
[CUSTOMER][NEUTRAL] Uh, the date is [PII]. The total bill amount is $488.02.
[AGENT][NEUTRAL] It looks like we received that claim on [PII].
[AGENT][NEUTRAL] That was processed on [PII].
[AGENT][NEUTRAL] And
[AGENT][NEGATIVE] So the office visit charge was denied because it's not covered under the plan.
[AGENT][NEUTRAL] And the other charges.
[AGENT][NEUTRAL] Benefits are only payable if the major medical insurance provider provides benefits.
[AGENT][NEUTRAL] The claim is later paid by major medical insurance, please send an explanation showing benefits were paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For the CPT code 99203, we have added a modified 25, right?
[AGENT][NEUTRAL] That that CPT code, that charge is not covered under the policy.
[CUSTOMER][NEGATIVE] But initially it got denied for uh not like it's been included with another CPT and then it's been denied again it's not covered under the plan, right?
[AGENT][NEUTRAL] It's not covered under the plan, correct.
[CUSTOMER][NEUTRAL] But why it's not covered under the plan?
[CUSTOMER][NEUTRAL] Just a minute.
[AGENT][NEUTRAL] How the policy is written.
[CUSTOMER][NEUTRAL] I'll just go and see the history.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 99203, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] Mm yeah we didn't get any payment.
[AGENT][NEUTRAL] Correct, it's not covered under the policy.
[CUSTOMER][NEUTRAL] It's uh only primary secondary for the member.
[AGENT][NEUTRAL] Secondary.
[CUSTOMER][NEUTRAL] 9920.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] So primary is like just a minute.
[CUSTOMER][NEUTRAL] Primary.
[CUSTOMER][NEUTRAL] UC, right?
[AGENT][NEUTRAL] United Healthcare.
[CUSTOMER][NEUTRAL] Like Optum.
[CUSTOMER][NEUTRAL] Yeah yeah.
[CUSTOMER][NEUTRAL] So what did the primary did for the CPT code?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] What did the primary pay?
[CUSTOMER][NEUTRAL] Uh, is primary paid the for the CPT code?
[AGENT][NEUTRAL] I pull up the EOB. It's just the, it doesn't matter what they paid, it's not covered under the policy.
[AGENT][NEUTRAL] So this policy does not cover office visits. It doesn't cover any charges for office visits, regardless of what the primary does.
[CUSTOMER][NEUTRAL] So there's no other active insurance right for this member?
[AGENT][NEUTRAL] Not, not that I can see, uh.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Policy don't.
[CUSTOMER][NEUTRAL] Cover the offices it's.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the claim begin on [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Could you send the claim number?
[AGENT][NEUTRAL] 356-3015.
[CUSTOMER][NEUTRAL] 356-3015 OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I don't go the offices it's OK.
[CUSTOMER][NEUTRAL] OK. Could you please tell me the
[CUSTOMER][NEUTRAL] Uh-huh, um, a time limit.
[AGENT][NEUTRAL] 180 days after the process date.
[CUSTOMER][NEUTRAL] Sorry, uh, from there?
[AGENT][NEUTRAL] 180 days after the process date.
[CUSTOMER][NEUTRAL] OK, process it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How can you submit the a bill through mailing address or fax number? Is there any fax number do you have?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And mailing address please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For appeal
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Please spell your name.
[AGENT][NEUTRAL] [PII], it's [PII]
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Call reference number please.
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][POSITIVE] OK, [PII], thanks for the information provided to me. Have a wonderful day.
[AGENT][POSITIVE] OK, thanks for calling APLU you as well.