AccountId: 011433970860
ContactId: 81eed0eb-bf9f-4168-996b-ca773ce62598
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 373190 ms
Total Talk Time (AGENT): 101044 ms
Total Talk Time (CUSTOMER): 138823 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/81eed0eb-bf9f-4168-996b-ca773ce62598_20250429T14:48_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] speaking from provider's office, and I'm calling regarding claim status.
[AGENT][NEUTRAL] OK, and I missed your name. What was that?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hey, [PII], do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Uh yes, I have it's 01989389.
[AGENT][NEUTRAL] And do you have a good callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] And last name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] And you were needing claim status, is that correct?
[CUSTOMER][POSITIVE] Yeah, that's correct, ma'am.
[AGENT][NEUTRAL] OK, uh, date of service and bill charges?
[CUSTOMER][NEUTRAL] Uh, date of service is [PII] and total charge amount is $215.
[CUSTOMER][NEUTRAL] And can you please uh spell out your name for me? Sorry, I didn't catch it.
[AGENT][NEUTRAL] Um, it's [PII], it's [PII]
[CUSTOMER][POSITIVE] Thank you and last initial?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh, it looks like this claim was received 7-8-2024. That was processed 7-11-2024.
[AGENT][NEUTRAL] And let me see.
[CUSTOMER][NEUTRAL] And can you give me the claim number?
[AGENT][NEUTRAL] My number is 347-953-5.
[AGENT][NEUTRAL] It looks like office visits are not covered under the policy.
[AGENT][NEUTRAL] And then it looks like.
[AGENT][NEUTRAL] Policy does not provide a benefit for which no charges were incurred.
[AGENT][NEUTRAL] That was for two of the um codes.
[CUSTOMER][NEUTRAL] Uh, office visits are not covered under patient's plan, right?
[AGENT][NEUTRAL] And then
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so this claim is denied, correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] One moment please.
[CUSTOMER][NEUTRAL] Is it possible for you to fax me a copy of COB?
[AGENT][NEUTRAL] Yes, what's your facts?
[CUSTOMER][NEUTRAL] 01 moment, let me double check to make sure I'm providing you the correct one.
[CUSTOMER][NEUTRAL] OK, the fax number is [PII].
[AGENT][NEUTRAL] OK, I'll get that faxed over. It just takes about 5 minutes.
[CUSTOMER][NEUTRAL] OK, uh, what was the denial?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, the first reason was that the office are not the patient's policy or plan and what was the second reason of denial.
[AGENT][NEUTRAL] Uh, the insurer, primary insurance provided full benefits, therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] Sorry ma'am you is cutting it out.
[AGENT][NEUTRAL] Yeah, you're cutting in and out too, so I'm not sure which side we're on, um.
[CUSTOMER][NEUTRAL] Oh, I think it's a connection problem.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] So the insured primary insurance provided full benefits, therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] Paid full benefits, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] There are no other benefits payable.
[AGENT][POSITIVE] Uh, correct.
[CUSTOMER][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And uh by the way, what is the timely filing limit uh for APL if we are uh doing any correction on the claim or we are sending back a claim back for processing or we are doing attendees.
[AGENT][NEUTRAL] An appeal is 180 days from the process date.
[AGENT][NEUTRAL] And then correct it.
[CUSTOMER][NEUTRAL] Uh for for resubmission a claim mhm.
[AGENT][NEUTRAL] For for an appeal if you're sending an appeal, if you're appealing the decision on the claim.
[AGENT][NEUTRAL] 180 days from the process date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the corrected claim.
[AGENT][NEUTRAL] Uh, there's no limit.
[CUSTOMER][NEUTRAL] There's no limit. OK, OK, so thank you for your assistance. Uh, have you faxed me a copy of your?
[AGENT][NEUTRAL] No, I'll fax it when we're off the call.
[CUSTOMER][NEUTRAL] Yeah, OK, no problem. Uh, hope I will receive it soon. And may I know, uh, may I get the call reference number?
[AGENT][NEUTRAL] Uh, call reference is my name, [PII], and then today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] OK then thank you so much for your assistance and have a good day.
[AGENT][POSITIVE] Thank you for calling APL you as well.