AccountId: 011433970860
ContactId: 66ce5c9c-5dca-4966-b078-0d52653f3e0c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 958630 ms
Total Talk Time (AGENT): 286325 ms
Total Talk Time (CUSTOMER): 211098 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/66ce5c9c-5dca-4966-b078-0d52653f3e0c_20250423T12:21_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh hi, [PII]. This is [PII] calling from the provider's office to check on a claim status.
[AGENT][POSITIVE] OK, I'm so sorry. What was your name?
[CUSTOMER][NEUTRAL] [PII] and my last name is [PII].
[AGENT][NEUTRAL] Hey, [PII] and you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Uh, yes, I have 2 creams.
[AGENT][NEUTRAL] OK, are your two clients for the same patient or for different patients?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Same day.
[CUSTOMER][NEUTRAL] Uh, for the same patient.
[AGENT][NEUTRAL] OK. Yes, ma'am. I can help you. And what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] The policy number is
[CUSTOMER][NEUTRAL] Just 1 2nd.
[CUSTOMER][NEUTRAL] The policy number.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] It's 11048.
[CUSTOMER][NEUTRAL] 56
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, the policy number is 2128207.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And any information that I provide for you, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] The patient's name is?
[CUSTOMER][POSITIVE] [PII].
[CUSTOMER][NEUTRAL] And the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. What is the first day of service and to build amount?
[CUSTOMER][NEUTRAL] And the date of service is.
[CUSTOMER][NEUTRAL] [PII]. And the charge amount is
[CUSTOMER][NEUTRAL] It's $157 even.
[AGENT][NEUTRAL] OK, so first of Rose, do you
[AGENT][NEUTRAL] I have an old policy number that turned, um, before your data service, the policy number that you gave to me actually turned 31 of 2022.
[AGENT][NEUTRAL] So I need to give you a different policy number?
[CUSTOMER][NEUTRAL] So it's 021-736-04.
[AGENT][NEUTRAL] That's the correct policy number, but that's not the one you initially gave me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So sorry.
[AGENT][NEUTRAL] So one moment for me to get that information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sorry
[AGENT][NEUTRAL] OK, so this claim was received, Rose.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The received date was [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And it was processed the same day.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There was a benefit paid in the amount of.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0.02 cents.
[AGENT][NEUTRAL] And that was paid on check number 200.
[AGENT][NEUTRAL] 523 6.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And it did clear on [PII].
[AGENT][NEUTRAL] Can not, oh.
[AGENT][NEUTRAL] The denial reasons for the other codes.
[AGENT][NEUTRAL] Where office visits are not covered by this policy, they may not cover office visits?
[AGENT][NEGATIVE] And then there were 3 other codes on there that state and then I remark was that there was no charge for the service of this policy does not provide a benefit for services in which no charges were incurred.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So the CPT 99213 is denied because they do not cover office visit.
[AGENT][NEUTRAL] Yes, the member's plan, supplemental plan does not cover office visits.
[CUSTOMER][NEUTRAL] Uh, Medicare supplementary plan.
[AGENT][NEUTRAL] This is a this is not a Medicare supplement.
[CUSTOMER][NEUTRAL] Oh yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so, uh, and the CPT G 2211 is denied, right? May I know the address, sir?
[AGENT][POSITIVE] As again, I stated 2.02 cents was paid on that and the check did clear.
[CUSTOMER][NEUTRAL] So that if it is not denied.
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] 0.02 cents was paid on that code.
[CUSTOMER][NEUTRAL] OK. So what do we have to do for this, the CPT?
[AGENT][NEUTRAL] This plan only
[AGENT][NEUTRAL] Helps with co-pays, deductibles and co-insurance amounts.
[CUSTOMER][NEUTRAL] OK, so how can we pay for that CPT 99213? Can we get paid?
[AGENT][NEUTRAL] We do not determine, we do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] OK. Then just one second.
[AGENT][NEUTRAL] I'm sorry, [PII], what did you say?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Are you the secondary?
[AGENT][NEUTRAL] We are
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, then.
[CUSTOMER][NEUTRAL] Uh, can I go with the next date of service?
[AGENT][NEUTRAL] And what is the
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And the charge amount is $368 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] This claim was received on [PII].
[AGENT][NEGATIVE] It was denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is going to be 31.
[AGENT][NEUTRAL] 4372.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And just one moment remarks for for the denial.
[AGENT][NEUTRAL] OK this
[AGENT][NEUTRAL] [PII] states we have received the primary benefits that was submitted with your claim. However,
[AGENT][NEUTRAL] The explanation of benefits received.
[AGENT][NEUTRAL] Does not list the amounts applied to the deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Please submit a more detailed explanation that shows these amounts for further consideration of the claim.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Uh, sorry, could you please repeat that journalism again? Your voice is breaking.
[AGENT][NEGATIVE] This denial states we have received.
[AGENT][NEUTRAL] The primary explanation of benefits that was submitted with your claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] However,
[AGENT][NEUTRAL] The explanation of benefits received.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] Does not.
[AGENT][NEUTRAL] List the amounts.
[AGENT][NEUTRAL] Applied to the deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] I think that uh I don't know.
[AGENT][NEUTRAL] Please submit.
[AGENT][NEUTRAL] A more detailed.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Explanation of benefits.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That shows these amounts.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] For further consideration.
[AGENT][NEUTRAL] Of your claim.
[CUSTOMER][NEUTRAL] So we have to submit the primary EOB?
[AGENT][NEUTRAL] A detailed primary EOB showing the amounts applied to the deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], you may go to our portal now that you have the.
[CUSTOMER][NEGATIVE] So it's denied for
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] You may print the explanation of benefits with these remarks on there. If you go to our website at [PII], now that you have the claim numbers.
[CUSTOMER][NEUTRAL] OK. So this claim is denied for a detailed primary you will be showing deductible copy and insurance, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, then. Can I get the call reference number?
[AGENT][NEUTRAL] Yes, ma'am. You would use my name.
[AGENT][NEUTRAL] Again, my name is [PII].
[CUSTOMER][POSITIVE] OK, then. Thank you, [PII]. Thank you for your assistance. Have a good day. Bye.
[AGENT][POSITIVE] You're welcome. Yes, ma'am. Yes ma'am. You too, [PII]. Is there anything else I can help you with this morning?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK. Well, thank you for calling APO and I hope that you have a very nice day.
[CUSTOMER][NEUTRAL] OK, you too, bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.