AccountId: 011433970860
ContactId: 84ded3b0-0bc0-42bc-87dc-ffe809c78819
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 456220 ms
Total Talk Time (AGENT): 187849 ms
Total Talk Time (CUSTOMER): 139979 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/84ded3b0-0bc0-42bc-87dc-ffe809c78819_20250513T18:32_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. Uh, you're speaking with [PII]. My first and last insured, [PII]. We are calling on behalf of the provider's office to check the claim status. Can you please help me for the pricing?
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][POSITIVE] Yeah, you're right.
[AGENT][POSITIVE] Yes, I can help you with that, [PII]. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Yeah, sure. It's a direct line. We don't have an extension. And the number we have like uh [PII].
[AGENT][NEUTRAL] Thank you and how many claims, [PII], do you have to check the status on today?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Uh, today, I have like uh only one client, uh, to check the status.
[AGENT][NEUTRAL] OK, yes, sir. I can help you with that. And what is your um patient's policy number, please?
[CUSTOMER][NEUTRAL] Yeah. Uh, the enrolling member ID of this particular member, uh, we found like uh 02544034.
[AGENT][POSITIVE] OK [PII] thank you give me a couple of moments please to get the member's information all pulled up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And seeing any information that is provided today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Uh, last name of the patient, we have [PII]. First name [PII], and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] Sure. And the service for this claim, uh we have like uh [PII] and the total charge amount of the claim, 6, yeah, [PII], and the total charge amount of the claim.
[AGENT][NEUTRAL] April.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, wait, one moment. I'm sorry. Hold on one second, [PII]. OK, [PII]. OK, and the amount?
[CUSTOMER][NEUTRAL] Sure, sure, sure.
[CUSTOMER][NEUTRAL] Yeah. Uh, the total charge amount of the claim is found like uh 696 dollars.72.
[AGENT][NEUTRAL] I'm sorry, 696.72. Is that correct?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Yeah, you're right.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] You make something.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] like
[AGENT][NEUTRAL] OK, [PII], so this claim was received, the received date on it was [PII].
[AGENT][NEUTRAL] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sh
[AGENT][NEUTRAL] And on here code 99214 was denied because office visits are not covered under the supplemental policy, the member's plan does not cover office visits.
[AGENT][NEUTRAL] And for the other two codes, the denial is because we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] So you need your primary, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Great
[CUSTOMER][NEUTRAL] Uh, so, need primary means we need to again resubmit the claim to the primary payer or
[AGENT][NEUTRAL] You need to send us there.
[AGENT][NEUTRAL] You need to send, you need to send APL.
[AGENT][NEUTRAL] The patient's primary insurance company's explanation of benefits for this data service and build them out.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This is a supplemental policy with APL, so we have to have a copy of the primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] When we're reviewing claims.
[CUSTOMER][NEUTRAL] OK, for the first time CPT for what reason has been denied, uh, can you please repeat that?
[AGENT][NEUTRAL] Office, the office visit code was denied.
[CUSTOMER][NEUTRAL] OK, so that was the office is it? It was not covered under the insurance plan, right?
[AGENT][NEUTRAL] Correct, the member's plan does not cover office visits under the supplemental policy.
[AGENT][NEUTRAL] And if you need a copy of the explanation of benefits with that remark with those remarks on there now that you have the claim number you can print that from our portal if you go to secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] And I can provide you our fax number, [PII], if you want to fax that explanation of benefits.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah, sure. OK. What was the fax number?
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] Our fax number here at APL is are you ready?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 1
[AGENT][NEUTRAL] 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][POSITIVE] Sure. Thanks so much. Can I get the claim number and the conference number?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] The claim number is 3592026.
[CUSTOMER][NEUTRAL] Can I get the contact number?
[AGENT][NEUTRAL] You would use my name along with today's date.
[CUSTOMER][POSITIVE] Yeah, thank you so much, [PII], uh, for calling this all information there.
[AGENT][NEUTRAL] OK, well, you're welcome, [PII].
[AGENT][NEUTRAL] Sure. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Yeah, enjoy the show. OK, bye.
[CUSTOMER][NEUTRAL] Uh, no. Do they have only one flight?
[AGENT][POSITIVE] OK, well then thank you for calling APL and I hope you have a nice day also, [PII].
[CUSTOMER][NEUTRAL] Uh, yes, I'm really sorry for the interruption. Uh, what is the time defending limit to submit that, uh, UOB?
[AGENT][NEGATIVE] There is no timely filing limit?
[CUSTOMER][POSITIVE] Yeah, yeah, you're right.
[AGENT][NEUTRAL] Yes sir, no timely filing limit.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][POSITIVE] Yeah. Nice. Uh.
[CUSTOMER][NEUTRAL] Just I need to confirm the claim number 3592026, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Yeah, thank you so much, [PII], for all the information and uh you have a wonderful day. Take care. Bye.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well
[AGENT][POSITIVE] Well I hope you do too, [PII]. Thank you again.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Yeah, sure, bye.