AccountId: 011433970860
ContactId: 7acc22c6-3a06-452b-85df-864353bc2454
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 743799 ms
Total Talk Time (AGENT): 200773 ms
Total Talk Time (CUSTOMER): 440262 ms
Interruptions: 10
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/7acc22c6-3a06-452b-85df-864353bc2454_20250421T20:33_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for the provider to check on the claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. So may I know how can I help you with the patient's information or the provider's information?
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status. May I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII]. No extension it's a direct line.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the policy number when you're ready.
[CUSTOMER][NEUTRAL] Yeah, the policy number is.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] 02517181 M as in Mike. L as in Lima, 8.
[AGENT][NEUTRAL] 02517181.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, yeah, the member's first name, the member's first name is [PII] and the last name is [PII], and the date of birth will be [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] [PII], uh yeah, the total date of service is [PII] and total bill amount is $260 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] It's 868254869. [PII] is speaking.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, the provider's office on the claim is
[CUSTOMER][NEUTRAL] Cardiovascular Medicine Associates.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] Thank you for that. I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] The claim number is 356.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 7991.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] And on [PII], the claim was denied as office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] OK, on the patient's plan, as for the patient's plan, the office visits are not covered under the patient's plan?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, office visit.
[CUSTOMER][NEUTRAL] 2616.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK, uh, so.
[CUSTOMER][NEUTRAL] The dinner date is [PII] I right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, just a moment. And could you please tell me which CPT code is not covered under the patient's plan?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's 976-503-23.
[AGENT][NEUTRAL] There's only one code on the claim, 99214.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what will be the timely filing limit to submit the corrected claim?
[AGENT][NEGATIVE] There's no timely filing for a corrected claim.
[CUSTOMER][NEUTRAL] OK, what will be the mailing address to submit the credited claim?
[AGENT][NEUTRAL] [PII] excuse me, [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] It happens when like just call back once again for you.
[CUSTOMER][NEUTRAL] OK, and timely filings, uh, to submit an appeal will be 180 days from the process date or the date.
[AGENT][NEUTRAL] 180 days from the denial date.
[CUSTOMER][NEUTRAL] Yeah, sure, so the business name.
[CUSTOMER][NEUTRAL] OK, and the mailing address to submit an appeal will be the same. Am I right?
[AGENT][NEUTRAL] Yes, but you put um APL appeals versus APL claims department.
[CUSTOMER][NEUTRAL] OK, APL appeals.
[CUSTOMER][NEUTRAL] OK. And could you please tell me, is there any specific form for a nappy?
[AGENT][NEUTRAL] No, there's no specific forms for the appeal, um, just, just something to show that this was not done in the office.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] It's 19.
[CUSTOMER][NEUTRAL] OK, and the claim number which you gave me is 356-799-1.
[AGENT][NEUTRAL] If it wasn't.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, and then you be required while submitting an appeal or corrected claim.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, is denied you'll be required while submitting a corrected claim or an appeal.
[AGENT][NEUTRAL] Um, no, you don't have to submit the, the, um, EOB if you're appealing.
[CUSTOMER][NEUTRAL] OK. Uh, and while submitting a corrected claim, we need to submit the denied you?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] The Call reference number for our conversation will be.
[AGENT][NEUTRAL] There's no call reference number, but you can use my name in today's date. Again, that's [PII] is [PII].
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] OK, and uh could you shall we move to the next claim?
[AGENT][NEUTRAL] Oh, OK. And how many claims do you have in total?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, this is the last claim.
[AGENT][NEUTRAL] Is it for the same member?
[CUSTOMER][NEUTRAL] No, for the different member and I'm looking for an apple status for this member.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And may I have the next policy number?
[CUSTOMER][POSITIVE] Yeah, sure. Take your time.
[CUSTOMER][NEUTRAL] The policy number will be 02286528 M as in Mike, L as in [PII] 8.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] My name is [PII], but so it's a clinic.
[AGENT][NEUTRAL] Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] And the member's first name, I would like to spell, it's [PII], and the last name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth of the member is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service and the total bill?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[CUSTOMER][NEUTRAL] And the bill amount will be $616 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And would the provider on this claim be the same or would it or would it be different from the other one?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is a different. It's [PII] we, OK.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so I'm not showing that we've received any appeal or it's just the original claim on file. Did you want that claim status?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, no, because, OK, we have submitted. Do you need the an appeal then we have submitted an appeal.
[AGENT][NEUTRAL] Um, you can give me the date, but when I put the date of service, everything will populate, but I can look and see if anything was received around the time that you sent the appeal.
[CUSTOMER][NEUTRAL] The date, the date we have submitted an appeal was [PII].
[CUSTOMER][NEUTRAL] And we have submitted a bill, I think so to the wrong address because the address over shows here is [PII].
[AGENT][NEUTRAL] Yeah, I'm not sure what address that is, um, but you can, I mean, if you want, if you're wanting to appeal this as well, you definitely can. It was denied because it's not covered when in a doctor's office or clinic, but if you want to appeal it, you definitely have that option.
[CUSTOMER][NEUTRAL] But we have done that
[CUSTOMER][NEUTRAL] OK, so, uh, it is not on file, am I right? OK, just a moment.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, could you please tell me original claim timely filing limit?
[CUSTOMER][NEUTRAL] OK that's
[AGENT][NEUTRAL] It'll be the same. There's no timely filing limit um for a correct the claim for an appeal, it's 180 days from the denial date.
[CUSTOMER][NEUTRAL] No I'm asking about the
[CUSTOMER][NEUTRAL] Uh, original claim, is there any timely filing limit or no?
[CUSTOMER][NEUTRAL] So then I did this one.
[AGENT][NEUTRAL] There's no timely filing limit. As long as the policy was active on the data service, you can file a claim.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK, and for the mailing, uh, OK.
[CUSTOMER][NEUTRAL] OK just a moment let me.
[CUSTOMER][NEUTRAL] Sorry [PII] or [PII] for appeal it's 180 days from the denial date. Am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] It is [PII], right?
[CUSTOMER][NEUTRAL] OK, and denied is not required for submitting an appeal.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And could you please tell me, uh, the, is there any specific attention to the appeals?
[AGENT][NEUTRAL] It would only be APL appeals versus attention APL claims.
[CUSTOMER][NEUTRAL] Yeah and I'm finding is to do.
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][POSITIVE] OK great.
[CUSTOMER][NEUTRAL] There is no specific form for an IP and could you please, OK, there is no appeal on file, so there will be no claim number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, OK, just to confirm, appeal's mailing address and contacted claims mailing address is the same, and it states [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, and the ID is not required.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] So that you'll be, no, it's not required.
[CUSTOMER][NEUTRAL] OK, so at the end of the day your call reference number.
[AGENT][NEUTRAL] Um, for the entire call, it will be my name and today's date. [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] On the.
[CUSTOMER][POSITIVE] OK, thank you, uh, [PII], for your assistance. I love the partnership and have a great day ahead.
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][POSITIVE] Alright. Well, thanks for calling APL. I hope you have a great evening.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, you too.