AccountId: 011433970860
ContactId: 7a0902df-571b-4962-99f9-9a3379e5ecb6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 446279 ms
Total Talk Time (AGENT): 134309 ms
Total Talk Time (CUSTOMER): 127347 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/7a0902df-571b-4962-99f9-9a3379e5ecb6_20250527T19:44_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]. My name is [PII], and I'm calling for provider's office to check on additional information about the claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes, and I will reach the UB, and I need some additional clarification on the denial. How are you doing today, [PII]?
[AGENT][POSITIVE] I'm doing good today, [PII]. How are you doing today, sir?
[CUSTOMER][POSITIVE] Uh, yeah, I'm doing great. Thank you so much for asking.
[AGENT][NEUTRAL] [PII], can I get your callback number, sir, just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Um, sure. The callback number is [PII]. And it is a direct line.
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] So, the patient's name is [PII], and the date of birth is [PII]. And the member ID is 021.
[CUSTOMER][NEUTRAL] 92256
[AGENT][NEUTRAL] OK, let me pull that up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, I've got [PII] pulled up. May I have her date of service and her charge amount?
[CUSTOMER][NEUTRAL] Sure, the date of service is [PII]. With a total charge amount of $624 even.
[AGENT][NEUTRAL] OK, and what are the charges after the primary insurance paid their part?
[CUSTOMER][POSITIVE] Um, yeah, the payment has been paid completely.
[AGENT][NEUTRAL] OK. And may I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm sure the facility name is Privia Medical Group.
[AGENT][NEUTRAL] OK, and you said this was a denied claim. What is the claim number you have?
[CUSTOMER][NEUTRAL] The claim number that I here is 358.
[CUSTOMER][NEUTRAL] 9285.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold [PII] while I look up this claim and I'll be right back sir.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. And for your information, I'm checking for the only procedure code 99213.
[AGENT][NEUTRAL] OK, I'll look on that EOB and see that information for you. I'm gonna put you on a quick hold and I'll be right back.
[CUSTOMER][POSITIVE] OK, you're fine take your time.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Oh shoot.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you, [PII], for holding for me. I have the claim information for you. So on the procedure code 99213.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] It was denied because office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] patients. OK, ma'am, may I know the patient's plan name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, got it all.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So basically, um, the this is not completely not covered in the business plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, got it. And may I know like what is the basic specific guidelines that you guys are following like Medicare, Medicaid, or something like that?
[AGENT][NEUTRAL] We don't follow any guidelines but our own on how the policy contract is written.
[CUSTOMER][NEUTRAL] Like American Life Insurance guidelines?
[AGENT][NEUTRAL] American Public Life, yes.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][POSITIVE] Public life guidelines. Thank you so much. And can I have the cat claim mailing address to some theater clients.
[AGENT][NEUTRAL] Yes, the claim mailing address is [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, got it. And what would be the family filing limit for current claim?
[AGENT][NEUTRAL] The correct claim correction there is no timely filing limit you just need to send a letter why it needs to be corrected.
[CUSTOMER][NEUTRAL] OK, got it. And also, can I have the actual mailing address for my documentation purpose?
[AGENT][NEGATIVE] It's the same address and an appeal needs to be done within 180 days from the date the claim was initially processed and it also needs a letter why you're appealing.
[CUSTOMER][NEUTRAL] OK, yeah, it's 18 days from process date and is there any attention to submit an a bill?
[AGENT][NEUTRAL] No ma'am no sir just the claims department.
[CUSTOMER][NEUTRAL] OK, got it. And the final question do we attach any pay specific apple form or just the cover letter? That would be fine.
[AGENT][NEUTRAL] Just cover letter is fine.
[CUSTOMER][NEUTRAL] OK, got it. And uh can I have the call reference number for the call then?
[AGENT][NEUTRAL] Yes sir, you can use my name [PII] in today's date.
[CUSTOMER][POSITIVE] Uh, um, I think that's all for today then, [PII]. Thank you so much for your assistance. Have a great day and bye for now.
[AGENT][POSITIVE] You too [PII] you have a wonderful day also and thank you for calling APL bye bye.