AccountId: 011433970860
ContactId: 8cd87fcb-5a0a-4f1b-95c9-6e3eb608b9b5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1249430 ms
Total Talk Time (AGENT): 275299 ms
Total Talk Time (CUSTOMER): 368113 ms
Interruptions: 20
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/8cd87fcb-5a0a-4f1b-95c9-6e3eb608b9b5_20250409T18:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling for provider office checking for the claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. May I please get your callback number just in case the call is dropped.
[CUSTOMER][NEUTRAL] How can
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Oh sure, which is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK, thank you and what's the patient's name, date of birth, and
[CUSTOMER][NEUTRAL] Sure. First name is [PII]. Last name is [PII], which is [PII] and then policy ID just a second.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Uh, which is 01.
[CUSTOMER][NEUTRAL] 622
[CUSTOMER][NEUTRAL] 812 M as in Mike. L as in Lima 8.
[AGENT][NEUTRAL] OK, let me pull up this policy real quick.
[AGENT][NEUTRAL] It's gonna be just a second.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, I've got it pulled up and what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] Uh, which is 16-2025.
[CUSTOMER][NEUTRAL] And Vermont.
[CUSTOMER][NEUTRAL] $150 even.
[AGENT][NEUTRAL] OK, and that was [PII]? I didn't catch that last date.
[CUSTOMER][NEUTRAL] I didn't catch that last day. Yes, [PII], billed with $150 even.
[AGENT][NEUTRAL] OK, and
[AGENT][NEUTRAL] And what is the charge amount the primary insurance paid their part.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] after the primary insurance pay their car.
[CUSTOMER][NEUTRAL] $150 even.
[AGENT][NEUTRAL] OK, and can you give me the name of the facility?
[CUSTOMER][NEUTRAL] Can you give me the name of Ventre Medical Associate.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim for us and I'll be right back.
[CUSTOMER][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim for us and I'll be right back. Sure, take your time.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, Ms. [PII], so looking on um.
[AGENT][NEUTRAL] The data service of [PII]. I've got the claim number it's 356.
[CUSTOMER][NEUTRAL] 2025 I've got the claim number.
[CUSTOMER][NEUTRAL] 356
[AGENT][NEUTRAL] 4
[AGENT][NEUTRAL] And the claim was denied because office.
[CUSTOMER][NEUTRAL] 356, after 356.
[AGENT][NEUTRAL] Yes, 356.
[AGENT][NEUTRAL] 7664.
[CUSTOMER][NEUTRAL] 64
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEGATIVE] And it was denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] And because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] When did your claim got received and denied?
[AGENT][NEUTRAL] OK, let me get that information for you.
[CUSTOMER][NEUTRAL] Let me get that information for you.
[AGENT][NEUTRAL] We received the claim on [PII].
[CUSTOMER][NEUTRAL] We saved the claim on [PII].
[AGENT][NEUTRAL] And processed it on also on the same day, [PII].
[CUSTOMER][NEUTRAL] And process it also on the [PII].
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Office visit doesn't cover for the mental like patient policy, which means like
[CUSTOMER][NEUTRAL] 99213 doesn't covered under the CPT also?
[AGENT][NEUTRAL] Right, office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Right, office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, is that possible, we have to raise some as a character claim and change the CPT?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] That is up to you. I can let you know there's not a time limit on corrections you just need to send the letter why you wanna correct it.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] That is up to you. I can let you know there's no time limit.
[CUSTOMER][NEUTRAL] Correction
[CUSTOMER][NEUTRAL] You just need to send you wanna correct it.
[CUSTOMER][NEUTRAL] I'm just asking about that you said office visit doesn't covered patient plan.
[CUSTOMER][NEUTRAL] So that is what I'm asking.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] The opposites are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] The opposites are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Whether it be inpatient service or outpatient service.
[AGENT][NEUTRAL] There is outpatient services, but also these visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] There is outpatient services, but also these visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] But previously that you
[CUSTOMER][NEUTRAL] Just a second I'm checking whether we got received any.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Payment or not.
[CUSTOMER][NEUTRAL] Just give me 1 2nd.
[AGENT][POSITIVE] Sure, go ahead and take your time.
[CUSTOMER][NEUTRAL] Uh, for the service [PII] that you guys will just pay the amount and again it be a recouped.
[AGENT][NEUTRAL] OK, um, all I can do is verify how the claim was processed if you feel you need to change the code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Verify how the time was processed.
[AGENT][NEUTRAL] Then you'll need to send in a claim correction. There's no time limit and you'll need a letter why you wanna change it.
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] That you said the office visit doesn't requiring for a patient plan, so that's why we have to change the CPT and again resubmit as a correct to a client.
[AGENT][NEUTRAL] That I'm going to leave that decision up to you. I can't advise on what you should do.
[CUSTOMER][NEUTRAL] That I'm going to leave that decision up to you. I.
[CUSTOMER][NEUTRAL] Why? Because, but previously we got on a payment.
[CUSTOMER][NEUTRAL] And the
[CUSTOMER][NEUTRAL] Patient.
[AGENT][NEUTRAL] Uh, you may have received a payment, but office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] For in this case, what we have to do?
[AGENT][NEUTRAL] I can advise you on how you should bill. I can just let you know that if you need to send a corrected claim, you can submit that with a letter why you want to change.
[CUSTOMER][NEUTRAL] I can't imagine
[AGENT][NEUTRAL] The claim why you need the correction.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Can I have a member's plan and type and effective?
[AGENT][NEUTRAL] Yes, the member's plan is Medlink.
[CUSTOMER][NEUTRAL] Yes, the next plan is Medin.
[CUSTOMER][NEUTRAL] Medlink. Can you spell that word?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am. It's MED.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. Time.
[AGENT][NEUTRAL] I'm sorry, type?
[CUSTOMER][NEUTRAL] the type of plan?
[AGENT][NEUTRAL] It's a secondary supplemental insurance.
[CUSTOMER][NEUTRAL] The secondary supplemental insurance.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Can I have members effective one term deal?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] The effective date is [PII].
[CUSTOMER][NEUTRAL] The effective date is [PII].
[AGENT][NEUTRAL] And there is no termination date, the policy is active.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Termination.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, can you, reason for the denial office visit doesn't required for the patient plan.
[AGENT][NEUTRAL] Correct. Would you like for me to send you the EOB if you give me your fax number, I'll send you the EOB.
[CUSTOMER][NEUTRAL] Because of
[CUSTOMER][NEUTRAL] Correct, would you like for me to send you the QB if you give me?
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] Oh, can you give me a reason, and then I have to give it to the, uh, fax number and you have to send us fax.
[AGENT][NEUTRAL] The reason is still the same. Office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] The reason it's not the same office visits.
[AGENT][NEUTRAL] It's non-covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] But it was an in-network, right?
[AGENT][NEUTRAL] I'm sorry, can you repeat that question?
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] The patient will be in-network or out of, out of network?
[AGENT][NEUTRAL] There's no network.
[CUSTOMER][NEGATIVE] That's not gonna work
[CUSTOMER][NEUTRAL] OK, the fax number which we have [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I get that fax ready and I'll be right back.
[CUSTOMER][NEUTRAL] OK, I'm gonna put you on a quick hold when I get that fax ready and we'll be right.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me [PII]. I have that fax on its way to you now.
[CUSTOMER][NEUTRAL] Now
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Is there anything else I can
[CUSTOMER][NEUTRAL] Oh yes, we have one another service here which is under the same patient. So can you check with that which is under the same denial that you guys have received.
[AGENT][NEUTRAL] OK, you have another claim for the same patient?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, so would be a different.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what is the date of service?
[CUSTOMER][NEUTRAL] OK. Uh, [PII] B $150 even.
[AGENT][NEUTRAL] OK, and what are the charges after the primary insurance paid their part?
[CUSTOMER][NEGATIVE] I can't go after the.
[CUSTOMER][NEUTRAL] Pay their part.
[CUSTOMER][NEUTRAL] The total amount insurance payment that you're asking?
[AGENT][NEUTRAL] Yes, what is the?
[CUSTOMER][NEUTRAL] Yes, what is the
[AGENT][NEUTRAL] Charges after the primary insurance paid their part.
[CUSTOMER][NEUTRAL] Charges after the primary insurance pays their part. Of 62 and 81.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And is it for the same facility?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And is it for the same facility? Yes, V, same patient, different service.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a brief hold while I look up that claim and I'll be right back.
[CUSTOMER][NEUTRAL] Alright, I'm gonna put you on a brief hold while I look you up that way and I'll be right back. OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me [PII]. So this one is the same situation, um, the claim number is 356.
[CUSTOMER][NEUTRAL] the number is 356.
[AGENT][NEUTRAL] 7659.
[CUSTOMER][NEUTRAL] It's 5.
[AGENT][NEUTRAL] The claim was denied because office visits are not covered by the patient's policy.
[CUSTOMER][NEUTRAL] The claim was denied because office visits are not covered by the patient's policy.
[CUSTOMER][NEUTRAL] OK, uh, if in case we have to size the character claim means, can I have a correct claim mailing address?
[AGENT][NEUTRAL] Yes, ma'am. That is going to be [PII].
[CUSTOMER][NEUTRAL] Yes ma'am, that is on BPO.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] That's in [PII].
[CUSTOMER][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The timely falling limit.
[AGENT][NEUTRAL] There's not one for a claim correction.
[CUSTOMER][NEUTRAL] There's not one for a correction.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] There's not a timely limit for a claim correction.
[CUSTOMER][NEUTRAL] For a plan correction. OK.
[CUSTOMER][NEUTRAL] Call reference for this call.
[AGENT][NEUTRAL] Yes, ma'am. You can use my name. It's [PII]
[CUSTOMER][POSITIVE] Yes ma'am, you can use my store.
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much for your assistance. Have a wonderful day.
[AGENT][POSITIVE] You have a wonderful day too, [PII]. Thank you very much for calling APL.
[CUSTOMER][POSITIVE] Yeah, OK, thank you so much for your assistance.
[AGENT][NEUTRAL] Bye bye.