AccountId: 011433970860
ContactId: 80d58226-3e59-4df0-aeea-14123faae50a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 619440 ms
Total Talk Time (AGENT): 171539 ms
Total Talk Time (CUSTOMER): 259011 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/80d58226-3e59-4df0-aeea-14123faae50a_20250616T20:27_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, this is [PII], and I'm calling for a provider to check on additional information about claim that has been. Please note this call will be monitored and recorded for quality and training purposes. How is your day going today, [PII]?
[AGENT][POSITIVE] I'm doing well, [PII]. How are you?
[CUSTOMER][POSITIVE] I'm doing good. Thank you so much for asking and I'm glad to hear that from your end too.
[AGENT][POSITIVE] You're very welcome and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, sure. It will be [PII]. It's a direct line and there is no extension.
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] 61
[CUSTOMER][NEUTRAL] Yes, sure. The member's policy number is
[CUSTOMER][NEUTRAL] It's 02586839.
[AGENT][NEUTRAL] Thank you, and I'll be more than happy to help with the claim status denial. Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it will be [PII], and the date of birth will be, it's [PII].
[AGENT][NEUTRAL] Thank you. May I have the claim number?
[CUSTOMER][NEUTRAL] Yes, sure. The claim number is 3606514.
[AGENT][NEUTRAL] OK, and what questions did you have in reference to the claim?
[CUSTOMER][NEUTRAL] Yes, I'm looking for the CPT code that is 99213 with modifier 25 denied as office visits are not covered by this policy. So could you please confirm uh that the office visit that is 99213 with modified to 5 are not covered under the member's plan or the payer guidelines.
[AGENT][NEGATIVE] It's not covered under the member's policy.
[CUSTOMER][NEUTRAL] Thank you. May I know what is the member's plan name is?
[AGENT][NEUTRAL] This is a Metlink supplemental gap insurance policy?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So, could you please provide me with the caller reference number for this claim?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date, which is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for that.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yes, I do have 2 more claims. Could you please assist me with that?
[AGENT][NEUTRAL] Is it the same member or a different member?
[CUSTOMER][NEUTRAL] It's for a different member?
[AGENT][NEUTRAL] OK, hold on one moment, let me note this policy.
[CUSTOMER][POSITIVE] Perfect, thank you, thank you for that.
[CUSTOMER][NEUTRAL] Yes, sure.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] wait what?
[AGENT][NEUTRAL] For now uh.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, hello, sir.
[CUSTOMER][NEUTRAL] Mhm, yes.
[AGENT][POSITIVE] Thank you so much for holding and the next member's policy number?
[CUSTOMER][NEUTRAL] Yes, sure. The next member's policy number is 1407899 M as in Mike, L as in Lima 7.
[AGENT][POSITIVE] Oh thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the member's name is
[CUSTOMER][NEUTRAL] [PII] and the date of birth will be [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, are you, do you need the claim denial for for this one as well?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm, yes, I'm looking for the specific code that is 99204 with modifier 25 stating as office visits are not covered by the above numbered policy. So, is it also the same that is uh the office visits are not covered under the member's plan?
[AGENT][NEGATIVE] Yes, that's for all of the, if this is, if that's the denial reason, that's the reason why it's the member's policy that's being denied because of the policy.
[CUSTOMER][POSITIVE] Thank you. And so, OK, thank you so much for the information you have provided. So, may I know what is the member's plan name? Is it the same or different?
[AGENT][NEUTRAL] Hold on one moment. Um, it's the same, it's a meddling policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Mhm thank you.
[AGENT][NEUTRAL] And what's the claim number that you're working with for this number?
[CUSTOMER][NEUTRAL] Yes, it will be 3606737.
[AGENT][NEUTRAL] 737 or 736?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] It's 737.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, it's a different policy number. OK, that's processed under policy number 2557208.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Not 1407899.
[CUSTOMER][NEUTRAL] OK. So is this member has a different policy?
[AGENT][NEUTRAL] So the the policy number that, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Excuse me, the policy number that you gave me is not the policy number that this claim is processed under. So the policy number that the claim is processed under is 255.
[AGENT][NEUTRAL] 7208.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the policy number you provided terminated on [PII].
[CUSTOMER][POSITIVE] OK. Thank you. Thank you so much for that.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So under this uh policy number, the members, uh, it is the office visits are not covered under the member's meddling supplemental gap insurance policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much for that. And also the call reference will be the same for the entire claims that we discussed in this call.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Thank you. And also, uh, could you please uh confirm when you have received this claim on your end? Is it on [PII]?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII], yes, you received that claim.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Is these are the information I needed. So shall we proceed with the last claim?
[AGENT][NEUTRAL] Um, hold on one moment, let me note this policy.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, it will be 01452842.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the member's name is.
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth will be [PII].
[AGENT][NEUTRAL] Thank you for that. And um may I have the claim number?
[CUSTOMER][NEUTRAL] Yes, the claim number is
[CUSTOMER][NEUTRAL] It's 3606614.
[AGENT][NEUTRAL] All right, and what questions did you have about the um claim?
[CUSTOMER][NEUTRAL] Yes, I'm looking for the CPT code that is 99214. So it is um stating as the same, that is, one moment.
[CUSTOMER][NEUTRAL] Office visits are not covered the above number policy. So it, it will be the same denial as we discussed earlier.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Thank you. So, the member has a medical supplemental gap insurance policy or different?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] It's the same um me link.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Thank you. So it will be the same that is meddling supplemental gap insurance policy, right?
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much. Yes, these are the information I needed. And also, could you please uh so may I know who responsible for this outstanding amount? Is it the provider or the patient?
[AGENT][NEUTRAL] We don't determine patient responsibility, um, that will be up to you as the provider to determine.
[CUSTOMER][NEUTRAL] OK. Thank you so much for the information you have provided. These are the information I needed, so the call reference for the entire three claims that we discussed will be your name and today's date, that is [PII] [PII], right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] Thank you so much for assisting me today. You have been a great help today. Have a great day and take care of yourself, [PII].
[AGENT][POSITIVE] Thank you also and thanks for calling APO. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm. Bye.
[CUSTOMER][NEUTRAL] 317