AccountId: 011433970860
ContactId: 80efb9a9-b5cd-44c0-99fe-42d6e0c40abb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 434869 ms
Total Talk Time (AGENT): 117062 ms
Total Talk Time (CUSTOMER): 180816 ms
Interruptions: 0
Overall Sentiment: AGENT=2.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/80efb9a9-b5cd-44c0-99fe-42d6e0c40abb_20241231T20:13_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]. How are you doing today?
[AGENT][POSITIVE] I'm doing well. How are you doing?
[CUSTOMER][NEUTRAL] Uh, [PII], uh, all good here too. My name is [PII] and I'm calling for Jennysto Medical Center to check on additional information about a claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes. I've already checked the UBN portal and need some additional information about the claim that has been denied.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] It would be my pleasure to assist you with that claim information, [PII]. What is a good callback number?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for um the claim number?
[AGENT][NEUTRAL] I can pull it up by claim number.
[CUSTOMER][NEUTRAL] Uh yes, it is 353.
[CUSTOMER][NEUTRAL] 9152.
[AGENT][NEUTRAL] Thank you, [PII] and what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh yes. The patient name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And this was for data service 1028.
[CUSTOMER][POSITIVE] Uh, that's correct.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Well it would be my pleasure to assist you, [PII]. Let me just get everything pulled up. Is there a specific question you have on the claim?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, yes, I can check here. Uh, 2 CPT code has been denied. That is, uh,
[CUSTOMER][NEUTRAL] Uh, that is 9923203 and uh another one is 99406. So, uh, uh, may I know why the CPT code has been, not been paid yet?
[AGENT][POSITIVE] Yes, sir, it would be my pleasure to assist you with that information. Now, this policy,
[AGENT][NEUTRAL] Only allows payment for outpatient surgery in an outpatient hospital or physician's office. So this procedure is not covered in an outpatient facility according to the guidelines of the policy.
[CUSTOMER][NEUTRAL] OK. Uh, I'm just uh writing down.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] 502-519 Y as in.
[CUSTOMER][NEUTRAL] Uh, all right. So it is not, uh, it is non-covered as per the provider's contract of the member's plan?
[AGENT][NEUTRAL] Members plan
[CUSTOMER][NEUTRAL] OK, not covered as per the member's plan. All right, just a second. So, may I know what kind of a member has the plan?
[AGENT][NEUTRAL] It is a limited hospital indemnity plan.
[CUSTOMER][NEUTRAL] Limited hospital indemnity plan.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, all right. I return in my notes. And uh just a second, I'm gathering some information.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, just provide me with the denial date and uh
[CUSTOMER][NEUTRAL] A denial date?
[AGENT][NEUTRAL] The denial date is [PII].
[CUSTOMER][NEUTRAL] [PII]. And if we need to resubmit the corrected claims, uh uh what is the uh corrected claim uh mode of submission via electronically portal or via fax, mailing address?
[AGENT][NEUTRAL] You can, mhm, you can.
[AGENT][NEUTRAL] Submit it via fax, I mean via via payer ID it's 60801 or you can fax it to the claims department at [PII].
[AGENT][NEUTRAL] 3659423
[CUSTOMER][NEUTRAL] All right, and uh just a sec.
[CUSTOMER][NEUTRAL] The mailing address for the corrected claim would remain the same. That is [PII] with the zip code [PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Uh, all right, all right, uh, just.
[CUSTOMER][NEUTRAL] Fax number is [PII]. That's correct?
[AGENT][POSITIVE] Yes, sir, that is correct.
[CUSTOMER][NEUTRAL] Uh, right, just a second.
[CUSTOMER][NEUTRAL] All right, and then the claim number would remain same, that is 353-9152. That's correct?
[AGENT][POSITIVE] Yes, sir, that is correct.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Uh, do member has, uh, uh, member has some other plan also?
[AGENT][NEUTRAL] Not with APL.
[CUSTOMER][NEUTRAL] Yeah, uh, oh, OK, just provide me with the call reference number and, uh, just, uh, uh, spell me your name.
[AGENT][NEUTRAL] The call reference number is my name and today's date. I spell my name [PII]
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] First initial of my last name is [PII].
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Uh, all right, [PII], thank you for your support today. Kindly appreciate it. Happy [PII].
[AGENT][POSITIVE] Well, it's been my pleasure to assist you. Happy [PII] to you and thank you for calling APL. Take care.
[CUSTOMER][NEUTRAL] I'm just writing some information after that I will hang up the phone, OK?
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Good.