AccountId: 011433970860
ContactId: 93c72911-cade-42e8-aa5d-2cab437ad13b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 583650 ms
Total Talk Time (AGENT): 224634 ms
Total Talk Time (CUSTOMER): 190713 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/93c72911-cade-42e8-aa5d-2cab437ad13b_20250318T18:46_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from provider's office to look for the claim status.
[AGENT][NEUTRAL] OK, [PII], well, I'll be more than happy to help you with the claim status and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Just one thing.
[AGENT][NEUTRAL] Alright, and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes. It is [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, of course. It was
[CUSTOMER][NEUTRAL] 02455481.
[CUSTOMER][NEUTRAL] M like Mike, L like Lima, 8.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, it is [PII]. Bill amount is $4,536 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So there were 2 claims to see that day. I'm gonna take a look at both. Do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Mhm. Yeah, sure.
[AGENT][NEUTRAL] All right. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 030.
[AGENT][NEUTRAL] OK, that's not it.
[AGENT][NEUTRAL] I know it was 000 920.
[AGENT][NEGATIVE] was voided is the one though.
[AGENT][NEUTRAL] Wait, so this is the this is the this is the reissue of the voided 030. So,
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][NEUTRAL] Hi, um, so for the, um,
[AGENT][NEUTRAL] Claim, hold on one moment. I just went.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is there a different total bill that can be on the claim because
[AGENT][NEUTRAL] The claims that we received for this data service is a different total bill.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Give me, yes, I think I have two different bill amounts. The billed amount is $3,204 even.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, yes, here we go.
[AGENT][NEUTRAL] So we originally, you want the original or the one, so the original claim was voided and it was reissued. Did you need the original or the reissued with the payment?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, I want to reissued, uh, claim with the payment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it was received on [PII]?
[AGENT][NEUTRAL] The claim number is 351-5030.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And also on [PII], we paid out on the claim a total of $70.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And did you need the check information?
[CUSTOMER][POSITIVE] Yes, of course.
[AGENT][NEUTRAL] OK, so a single check in the amount of $70.
[AGENT][NEUTRAL] I'm getting the check number for you now. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so the check number is 200.
[AGENT][NEUTRAL] 66669.
[AGENT][NEUTRAL] Um, it was issued on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the check cleared?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, for the CPT code, uh, give me one second. I think only one CPT code was paid for the amount of $70. For the CPT code 99203 with modified 25, it was denied for lack of information for verification. May I know what information is required and what is the exact denial for that CPT code?
[AGENT][NEUTRAL] Wait, wait, wait, hold on one second, let me see so I can match it with you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So yes, CP CPT code.
[AGENT][NEUTRAL] 76825 is the code that um was paid out the $70. The other the other um CPT code, let me see what this means, hold on one moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] OK. So, it was denied as non-covered, right?
[AGENT][NEUTRAL] Right, 99203 was.
[CUSTOMER][NEUTRAL] 99203. Um, but we have never built that seat. Give me one second. Yes. OK.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Is it not covered under the patient plan or not covered under the provider's contract?
[AGENT][NEUTRAL] Not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK. Uh, can I get the patient plan name?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So this is the Min supplemental insurance, so we apply towards the copay, deductible and co-insurance after primary.
[CUSTOMER][NEUTRAL] OK. Can you repeat that one more time?
[AGENT][NEUTRAL] Sure, it's a Medlink supplemental insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We apply to the co-pay, deductible and co-insurance of covered charges after primary.
[CUSTOMER][NEUTRAL] OK. What is the plan type of this number? Is it HMO, PPO, or EPO?
[AGENT][NEUTRAL] Neither. This is a secondary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All [PII]. Thank you so much for that one.
[AGENT][POSITIVE] You, you're very welcome. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, so, for the, uh, CPT 99203, is it uh patient responsibility or can we bill the patient for that?
[AGENT][NEUTRAL] So we don't determine patient responsibility because we're not the major medical. Um if there is an outstanding or remaining balance that would just be whatever your um policies or procedures are for a remaining balance, but we can't determine that because we're not major.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, all right. Uh, can I get the claim mailing address, the claim mailing address?
[AGENT][NEUTRAL] Sure, our claims mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK. Uh, what is the appeal mailing address?
[AGENT][NEUTRAL] The appeals mailing address is the same, it would just be attention appeals.
[CUSTOMER][NEUTRAL] OK. Uh, what is the timely filing to submit an appeal?
[AGENT][NEUTRAL] Um, it's 180 days from the denial.
[CUSTOMER][POSITIVE] OK. Thank you so much for that one, [PII]. Can I get the call reference number, ma'am?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII]. I wish you have a great day. Thank you so much for your assistance. Bye for now.
[AGENT][POSITIVE] You're welcome, [PII]. You also, was there anything else I can help with?
[CUSTOMER][POSITIVE] No, I just had this one claim. Thank you so much for asking that.
[AGENT][POSITIVE] Alright, thanks for calling. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.