AccountId: 011433970860
ContactId: 8be05ce7-7c53-4046-8c95-d0605376ff98
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 626849 ms
Total Talk Time (AGENT): 177417 ms
Total Talk Time (CUSTOMER): 192699 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/8be05ce7-7c53-4046-8c95-d0605376ff98_20250605T16:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII] calling from the doctor's office to check on the current status.
[AGENT][NEUTRAL] I'm sure [PII] I can assist you with claim status. Um, first I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Sure. Our callback number is [PII] direct line.
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Sorry, can you please go again?
[AGENT][NEUTRAL] Um, yes, ma'am. I need the policy number, the patient's policy number that you're calling about.
[CUSTOMER][NEUTRAL] Yes, it is 02455544.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] This is for member [PII] [PII].
[AGENT][NEUTRAL] Thank you. Now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] This is regarding the date of service, [PII] for the total bill amount of $1250.57.
[AGENT][NEUTRAL] OK. Yes, ma'am. I'm waiting on my system. One moment, please.
[AGENT][NEUTRAL] OK, you said that was for [PII] for $1250.57?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Yes, ma'am. We received that claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, the claim number is 3577021.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And I'm showing that this
[CUSTOMER][NEUTRAL] It's 357-702-1.
[AGENT][NEUTRAL] Yes, ma'am. That's the claim number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I'm showing that this claim denied um because according to the primary carrier EOB that was sent along with the claim, the primary insurance denied the charges. And if the primary insurance denied charges, then as they're secondary, we deny it also.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, but primary did process this claim and paid.
[AGENT][NEUTRAL] OK, yeah. We're showing, um, and if they pay line one, line one denied because office visits, co-pays for office visits is not covered. So that's why line one denied and then the other lines denied because the primary insurance denied those charges.
[CUSTOMER][NEUTRAL] OK, can you please just give me a moment here.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, because, uh, what information we have, we see here, um, the claim has been processed and paid by the primary.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK. What charge paid according to the primary insurance because of
[CUSTOMER][NEUTRAL] Uh, yeah, that's what I'm checking here, just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, just a moment please, my system is loading the information.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] OK. No problem.
[CUSTOMER][NEUTRAL] OK. So this claim?
[CUSTOMER][NEUTRAL] Um, it has been processed.
[CUSTOMER][NEUTRAL] And paid 100 and
[CUSTOMER][NEUTRAL] $36.55.
[AGENT][NEUTRAL] OK. Does it show which line, which line items paid?
[CUSTOMER][NEUTRAL] Yes, the first line 99213.
[CUSTOMER][NEUTRAL] It has been paid.
[AGENT][NEUTRAL] OK. And what about the other line items?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Actually, the, it's not 99213. It's 99203, which has been paid for $14 and 73,620 paid for $21.96. And 28515, it has been paid for $100. The only CPT, uh, the L4360.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] It has been applied towards the member's responsibility as deductible.
[AGENT][NEUTRAL] OK. One moment.
[CUSTOMER][NEUTRAL] Actually, uh, the primary, they have merged two data of services for the same patient, and they have processed. One is 926-2024 and [PII]. They have merged these two data services and they have processed the claim. Um, the line bill for 926-2024 is 992-0373620 L4360 and 28515.
[CUSTOMER][NEUTRAL] Which has been processed.
[CUSTOMER][NEUTRAL] By the primary, um, the 99213 and 73,620, um, that they have processed towards the copay for 73,620, that is for the date of service of [PII].
[AGENT][NEUTRAL] OK, yeah, but the claim, the date of service on the claim that we received is only for 9-26-2024.
[AGENT][NEUTRAL] So, a claim would need to be resubmitted for [PII].
[AGENT][NEGATIVE] For payment, uh, to receive payments, but according to the EOB we received, there is no uh coverage. There's no payment for 926-2024.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, can, can I submit the claim with the primary EOP again for which we have received the payment from primary for Corporation.
[AGENT][NEUTRAL] Yes, ma'am. You can, yes, you can, there's no timely filing limit. So if you have an updated explanation of benefits, it can be resubmitted.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh can you please verify me the address to which we can submit or is there a fax number?
[AGENT][NEUTRAL] Um, yes, you can fax it. Um, our fax number is.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] and please attention it to the claims department.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Sure.
[CUSTOMER][POSITIVE] Thank you. And uh there is no specific time frame, right?
[AGENT][NEGATIVE] Right, there's no timely filing limit.
[CUSTOMER][NEUTRAL] Thank you. And can I have a reference number for our call today?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. My name is [PII], um it's spelled [PII] My last initial is [PII], and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Um, thank you so much, [PII] That's all for today, huh.
[AGENT][POSITIVE] OK. Well, I thank you, [PII], for calling APL. You have a great day. Mm bye.
[CUSTOMER][POSITIVE] You too have a great day bye bye.
[AGENT][POSITIVE] Thank you.