AccountId: 011433970860
ContactId: 84f40438-00bd-4080-a5e0-e151ddfd8b57
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1750099 ms
Total Talk Time (AGENT): 700211 ms
Total Talk Time (CUSTOMER): 465273 ms
Interruptions: 14
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/84f40438-00bd-4080-a5e0-e151ddfd8b57_20250324T14:50_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for Vica to check on the claim status. Please be informed that this call has been recorded and monitored for quality and training purposes. May I know if I can help you with the provider's information or the patient's information?
[AGENT][NEUTRAL] Uh, yes, if I can help with the claim. And what is the policy number, please?
[CUSTOMER][NEUTRAL] Sure. The policy number is D as in Delta 43,302,090.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, that's not one of our policy numbers. Is there anything else, is there any other information such as the Social Security number that we can go by?
[CUSTOMER][NEUTRAL] I can provide the patient's name date of service.
[AGENT][NEUTRAL] OK. How do you spell the last name, please?
[CUSTOMER][NEUTRAL] The patient's last name is [PII].
[AGENT][NEUTRAL] And is that with an S or a Z?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] OK, thank you. And the first name?
[CUSTOMER][NEUTRAL] First name is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That's [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] Oh, [PII], thank you. And what is [PII]'s, uh, date of birth, please?
[AGENT][NEUTRAL] Thank you, is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Sure, the callback number is [PII] and that's a direct line, no extension.
[AGENT][POSITIVE] OK, thank you very much. I'm just checking now.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Is this for dental or medical?
[CUSTOMER][NEUTRAL] That's for medical.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah because I.
[CUSTOMER][NEUTRAL] Uh, so.
[CUSTOMER][NEUTRAL] Like
[AGENT][NEUTRAL] OK, I'm still checking.
[CUSTOMER][POSITIVE] Sure, [PII], take your time.
[AGENT][NEUTRAL] OK, I'm not finding a [PII]. Uh let me just check one other place.
[AGENT][NEUTRAL] I'm not finding a [PII] with that date of birth, let me put it that way. Let me just.
[AGENT][NEUTRAL] I'm still checking.
[AGENT][NEUTRAL] OK, I'm, I'm very sorry, uh, [PII], I don't have anybody by that name and that date of birth.
[CUSTOMER][NEUTRAL] OK. Should I provided the patient's address?
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Oh yes, that would be fine.
[CUSTOMER][NEUTRAL] For tax ID. OK. The patient's address is [PII]. And should I provide you the tax ID?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, no, I don't need that, um, but thank you. Let me see what I can find.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let's see. This might be it.
[AGENT][NEUTRAL] OK, and what is our date of service, uh, [PII]?
[CUSTOMER][NEUTRAL] date of service is [PII].
[AGENT][NEUTRAL] Is there a particular build amount that I should look for?
[CUSTOMER][NEUTRAL] Yes, the bill amount is $623 even.
[AGENT][NEUTRAL] OK, thank you. Well, first of all, his policy number is 02.
[AGENT][NEUTRAL] 474-924 and that went into effect on [PII]. It is active. Let me see if I can't find uh your claim.
[AGENT][NEUTRAL] So, for [PII]?
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And uh recently, we have submitted this claim on [PII].
[AGENT][NEUTRAL] OK. Did you receive a claim number from us, um, as well?
[CUSTOMER][NEUTRAL] No, I don't have a claim number.
[AGENT][NEUTRAL] Oh, OK, let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK so.
[CUSTOMER][NEUTRAL] I have one claim number that is 3562492.
[AGENT][NEUTRAL] OK, let's see if that comes up to anything.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like, uh, it looks like I do have another claim number. It's uh 35.
[AGENT][NEUTRAL] 37051. And that might be the most current one, so let's see what it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] It looks like they are showing this as being an inpatient hospital.
[AGENT][NEUTRAL] Uh, service.
[AGENT][NEUTRAL] Um, which the policy doesn't cover.
[AGENT][NEUTRAL] So it looks like we received um.
[AGENT][NEUTRAL] Let's see, we have a couple of different claims here. Let's see.
[AGENT][NEGATIVE] Checking here, there's a bunch of claims.
[AGENT][NEUTRAL] OK, so that was a duplicate. The one, the claim that you received ending in 492 was a duplicate. The most current uh or the, the one that the claim was that actually adjudicated on is 35.
[AGENT][NEUTRAL] 37051
[AGENT][NEUTRAL] So what it looks like is that they're listing this as an inpatient uh physician charge, and the policy doesn't pay for anything like that. It doesn't have any benefits for this type of service. So it looks like we received the claim.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] 7051.
[AGENT][NEUTRAL] Trying to see where.
[AGENT][NEUTRAL] I'm trying to see when we received this and when we processed it because it's
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, and, uh, could you please specify, uh, the duplicate date and original claim received date and denial date?
[AGENT][NEUTRAL] Uh yes, so the original claim that we received, the very first one, and this is the one that was, was denied as not having benefits for this type of service. We received that particular claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2024 and we processed it on [PII]. Now it looks like it was sent back to us.
[AGENT][NEUTRAL] Um, again,
[AGENT][NEUTRAL] With the same charges and, and uh
[AGENT][NEUTRAL] So it looks like that was um.
[AGENT][NEUTRAL] If if I can find it here.
[AGENT][NEUTRAL] 2562.
[AGENT][NEUTRAL] Right.
[AGENT][NEGATIVE] OK, so that the second claim that we received was on [PII]. This is the duplicate. [PII], it's when we received it, and [PII] is when we uh processed it. So the original claim that we received was on the [PII]. We processed that on, uh, [PII], and this is where we, uh, denied it because there were no benefits for this type of service. And then it looks like it was sent in again.
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] And it was denied as a duplicate.
[AGENT][NEUTRAL] And then we received that on [PII].
[AGENT][NEUTRAL] And process it on [PII].
[AGENT][NEGATIVE] But that is what has happened with these, uh, [PII], is that they're not, there's no uh there's no benefits for this, this type of service.
[CUSTOMER][NEUTRAL] OK, so see.
[CUSTOMER][NEUTRAL] OK. And uh the received and uh denied, it was denied on [PII]. Is that correct?
[AGENT][NEUTRAL] Yes, that's well, that was when the duplicate was denied, yes.
[CUSTOMER][NEUTRAL] OK, and original was denied on just a moment. Original was denied on [PII]. Is that correct?
[AGENT][NEGATIVE] Uh, yes, the very first one, the original that we received was denied on [PII] and that's uh because there were no benefits to cover the, the services.
[CUSTOMER][NEUTRAL] OK. And which if it is not covered as per patient policy?
[AGENT][NEUTRAL] It's for the patient's policy, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Which CPT was not covered?
[AGENT][NEUTRAL] Uh, the CPT code that was not covered, uh, let's just see here.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, so the one that was not covered.
[AGENT][NEUTRAL] But none of them were covered. Um, it's uh 99233.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] January.
[AGENT][NEUTRAL] 78452.
[AGENT][NEUTRAL] 93016.
[CUSTOMER][NEUTRAL] Uh what about that
[AGENT][NEUTRAL] 93018. So, so none of the CPT codes were covered.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you so much for that information, [PII]. And uh what is the timely filing to submit and corrected claim?
[AGENT][NEUTRAL] I
[AGENT][NEGATIVE] Uh, that, uh, there's no timely filing on these policies.
[CUSTOMER][NEUTRAL] OK. And what will be the mailing address to submit and correct it for?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] And our zip code
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Is there anything else at all I can help with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, and what will be the timely filing to submit an appeal?
[AGENT][NEGATIVE] Uh, there, there's no timely filing for that.
[CUSTOMER][NEGATIVE] For for appeal also, there is no timely filing?
[AGENT][NEUTRAL] 00, for the appeal, excuse me, I'm sorry, you have 180 days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And mailing address to send an appeal will be same or different?
[AGENT][NEUTRAL] It's exactly the same.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And is there any specific form for appeal?
[AGENT][NEUTRAL] I know there is not.
[CUSTOMER][NEUTRAL] This is
[CUSTOMER][NEUTRAL] OK. Could you please recon
[AGENT][NEUTRAL] But you, you just need to send it in as an.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And uh could you please reconfirm the claim number?
[AGENT][NEUTRAL] Uh, which one? The, the original or the duplicate?
[CUSTOMER][NEUTRAL] Both
[AGENT][NEUTRAL] OK, so the original claim.
[AGENT][NEUTRAL] Which was received on [PII].
[CUSTOMER][NEUTRAL] It was
[CUSTOMER][NEUTRAL] you said that.
[AGENT][NEUTRAL] 2024 and processed on [PII] is 35.
[CUSTOMER][NEUTRAL] You you know.
[AGENT][NEUTRAL] 37
[CUSTOMER][NEUTRAL] I don't know
[AGENT][NEUTRAL] 051.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK and.
[AGENT][NEUTRAL] The duplicate claim that was received on [PII] and processed on [PII] is 35.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 62492.
[CUSTOMER][POSITIVE] Thank you so much for reconfirming that. And what will be the call reference name and number for this claim? I have
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] I have 4 more claims for the patient, same patient, same provider.
[AGENT][NEUTRAL] OK, I
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The all the uh
[AGENT][NEUTRAL] All the callback references number reference numbers will be my name which is [PII], and today's date.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, [PII], Should I provide you the next date of service?
[AGENT][NEUTRAL] Yes, and what is that?
[CUSTOMER][NEUTRAL] It's [PII]. And the bill amount is $289 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] It looks like the uh claim number for this, there's actually 2 of them, so the original claim.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] The number for that is 353.
[AGENT][NEUTRAL] 7710.
[AGENT][NEUTRAL] And it looks like we received that. Let me just check here.
[AGENT][NEUTRAL] OK, so it looks like we received the first one.
[AGENT][NEUTRAL] The very first claim that we received from you.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] 6
[AGENT][NEUTRAL] Still checking.
[CUSTOMER][POSITIVE] Sure take your time.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] The very first claim that we received from you was on [PII].
[AGENT][NEUTRAL] 2024 that was processed on [PII].
[AGENT][NEUTRAL] 2025. Now, at that time, the claim was denied because the uh the um insured's policy does not cover this type of service.
[AGENT][NEGATIVE] So that was denied.
[AGENT][NEUTRAL] The duplicate was submitted on [PII].
[AGENT][NEUTRAL] [PII] and processed on [PII] as a duplicate.
[CUSTOMER][NEUTRAL] Which is uh was not covered and the patient was.
[AGENT][NEUTRAL] Uh, all of the CPT codes, right, yeah, each CPT code was not covered, so these, uh, the, um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And didn't have you.
[AGENT][NEUTRAL] Services in this case.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see, it looks like the CPT code.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That was 99233. That's 99233.
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEGATIVE] And that is not covered by this policy.
[CUSTOMER][NEUTRAL] Only one go, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. As you provided me the original claim number, what is the duplicate claim number?
[AGENT][NEUTRAL] The duplicate claim number is 356.
[AGENT][NEUTRAL] 2866.
[CUSTOMER][NEUTRAL] 356-2866. OK. And all the information, just like the family filing limit, mailing address, family filing to submit an appeal last same or.
[AGENT][NEUTRAL] That is exactly the same.
[CUSTOMER][NEUTRAL] OK, let's
[CUSTOMER][NEUTRAL] OK, let's move to the next claim then.
[AGENT][NEUTRAL] OK, and the next date of service.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK and the bill amount.
[CUSTOMER][NEUTRAL] The bill amount is $753 even.
[AGENT][NEUTRAL] Alright, let's just see what we have here.
[AGENT][NEUTRAL] OK, so the original claim for this.
[AGENT][NEUTRAL] It's 35.
[AGENT][NEUTRAL] 37,720.
[AGENT][NEUTRAL] So that's 35.
[AGENT][NEUTRAL] 37,720.
[AGENT][NEUTRAL] At the time that we received that particular claim,
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] That particular claim was uh
[AGENT][NEUTRAL] Received on
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] 2024 and it was processed.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] 2025.
[AGENT][NEUTRAL] There was a duplicate.
[AGENT][NEUTRAL] That was sent in
[AGENT][NEUTRAL] On the [PII], it was processed on [PII], and that duplicate number is 35.
[AGENT][NEUTRAL] 62
[AGENT][NEUTRAL] 49.
[AGENT][NEUTRAL] 7.
[CUSTOMER][NEUTRAL] And which CPT was not covered? OK, you may proceed.
[AGENT][NEUTRAL] There were 2 CPT codes.
[AGENT][NEUTRAL] Uh there are two CPT codes, uh 99255.
[AGENT][NEUTRAL] 9 and 93306. Neither one of those.
[AGENT][NEUTRAL] Codes were active. They, they were not covered, I should say. And this is for the patient's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So all the other information are the same, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, then let's forward to the next claim. Should I provide you the date of service?
[AGENT][NEUTRAL] Yes, uh-huh.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And the bill amount is?
[AGENT][NEUTRAL] In the build the amount?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] $289 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah I know.
[AGENT][NEUTRAL] Excuse me just a second.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding. It looks like we received your original claim.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] It was processed on [PII], and it was denied as there as the uh code, it was one code.
[AGENT][NEUTRAL] And that was 99233 was not covered by the patient's policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] What is the original claim number?
[AGENT][NEUTRAL] The original claim number is 353.
[AGENT][NEUTRAL] 7715.
[CUSTOMER][NEUTRAL] And duplicate claim number?
[AGENT][NEUTRAL] The duplicate claim number which we received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's 356 2.
[AGENT][NEUTRAL] 486.
[CUSTOMER][NEUTRAL] OK, so the claim was denied on [PII]. Is that correct?
[AGENT][NEUTRAL] Uh 125-2024 is when the the original claim was received on the [PII]. It was processed on the [PII], and that was when it was denied. And the CP code [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You have not
[AGENT][NEGATIVE] 233 was denied because that is not covered by the policy.
[CUSTOMER][NEUTRAL] Yes I have.
[CUSTOMER][NEUTRAL] OK. So all the information is same. So let's forward to the next claim. Should I provide you the next date of service?
[AGENT][NEUTRAL] And what is that date?
[AGENT][POSITIVE] Yeah, yeah, I'll need that.
[CUSTOMER][NEUTRAL] OK. The next
[CUSTOMER][NEUTRAL] The next state of service is.
[CUSTOMER][NEUTRAL] [PII] and the total bill amount is $289 even.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, this will be the last one that I can do, [PII].
[AGENT][NEUTRAL] Let's let's see if I can find that. [PII].
[AGENT][NEUTRAL] OK, so it looks like we received.
[CUSTOMER][NEUTRAL] I have one more claim.
[AGENT][NEUTRAL] OK, well that would be the last one that we can do, all right?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now the original claim number for this.
[AGENT][NEUTRAL] It's 353.
[AGENT][NEUTRAL] 7724.
[AGENT][NEGATIVE] Now, this was denied.
[AGENT][NEUTRAL] On
[AGENT][NEUTRAL] We received it on the [PII].
[AGENT][NEGATIVE] Excuse me, I'm sorry, we received it on the [PII] and we processed it on the, on the [PII], and this was denied because the CPT code 99233 is not covered.
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] Uh, this policy.
[AGENT][NEUTRAL] Now the duplicates.
[AGENT][NEUTRAL] Which was received on.
[AGENT][NEUTRAL] [PII] and processed on [PII].
[AGENT][NEUTRAL] It's 35.
[AGENT][NEUTRAL] 62,490.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All the information you see.
[CUSTOMER][NEUTRAL] I have last claim for the same patient.
[AGENT][NEUTRAL] OK, and what is the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] And the build out please.
[CUSTOMER][NEUTRAL] And the bill amount is $289 even. And that's the last claim for the day.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] OK, so it looks like our our original claim uh for this.
[AGENT][NEUTRAL] It's 353.
[AGENT][NEUTRAL] 771 2.
[AGENT][NEUTRAL] And that was received on [PII].
[AGENT][NEUTRAL] [PII] and processed on [PII].
[AGENT][NEUTRAL] Now there's a duplicate that we received and that claim number is 3562.
[AGENT][NEUTRAL] 863.
[AGENT][NEUTRAL] Now that
[AGENT][NEUTRAL] was received on the
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] and and processed on the [PII].
[AGENT][NEUTRAL] [PII]. And it's the same thing as before, um, that.
[AGENT][NEUTRAL] CPT code 99233 is just not going to be covered under these policies.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And that's all for the day.
[AGENT][POSITIVE] OK, well, thank you very much for contacting ATL. Have a good day.
[CUSTOMER][POSITIVE] Thank you so much for assist.