AccountId: 011433970860
ContactId: 99dfa1f5-2960-445c-9531-a9b71d57baa7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2175489 ms
Total Talk Time (AGENT): 595375 ms
Total Talk Time (CUSTOMER): 592968 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/99dfa1f5-2960-445c-9531-a9b71d57baa7_20250220T15:49_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from provider's office to check on your claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status. And [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Oh, I'm having.
[CUSTOMER][NEUTRAL] Uh 9 claims with me.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh yeah, sure. Uh, but before I proceed, please be informed that this call is being recorded for quality and training purposes. Would you like us to continue recording?
[AGENT][POSITIVE] Yes, you can continue with the call.
[CUSTOMER][POSITIVE] Yeah, thank you so much. And my callback number is, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] All right, and may I have the um the first member's policy number?
[CUSTOMER][NEUTRAL] Yeah, before that, could you please spell out your name?
[AGENT][NEUTRAL] Yes, my name is [PII], first initial of my last name is [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much for that. And the member ID is it uh 148032.
[CUSTOMER][NEUTRAL] 2 M as in Mike, L as in Lima, [PII].
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Oh yeah, sure. Uh, the name is, it's uh [PII], and the 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. May I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] Yes, uh, the date of service, it's number [PII] and the total bill amount it's $197.07.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Uh, skin and Cancer Associates.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] That claim number is 3535002.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Renas yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Denied on [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, but actually, uh, for this one, the APL is acting as a secondary.
[AGENT][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] So, the primary has paid, right?
[CUSTOMER][NEUTRAL] So why can't the secondary will pay?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Because the primary insurance policy has its own benefits and secondary policy has its own benefits. So for the secondary policy, office visits are not covered.
[CUSTOMER][NEUTRAL] OK. Uh, yeah. Can you please be on hold for a moment, [PII]?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Yeah, thank you so much.
[CUSTOMER][NEUTRAL] OK. Thank you so much for patiently waiting. Yeah, you mean to say that, uh, that is non-covered as per patient plan. OK. So, uh, so what is the reason for non-co uh this provider is out of network or uh DS or ICT1 you will not covered under the patient plan?
[AGENT][NEUTRAL] Neither. Office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK, office visits are not good. OK. Uh, can you please, uh, send any your video fax?
[AGENT][NEUTRAL] Sure, well, you need um explanation of benefits for all the claims we go over today?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is a good fax number for you?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And would that be attention, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's my name.
[AGENT][NEUTRAL] OK, and that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. But before that, uh, can you please uh tell me what is the turnaround time to receive any UB?
[AGENT][POSITIVE] So because there's 9 claims, I'll send them all at the end of the call. We usually say to give, to give it about an hour to receive a fax. If you have not received it by end of day today, you can definitely give us a call and we'll be more than happy to resend it for you.
[CUSTOMER][NEUTRAL] OK. I will mention in my note as 24 hours, OK? If not, then we will call back.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, for this one, can we bill to the patient?
[AGENT][NEUTRAL] So APL doesn't determine patient responsibility because we're not a major medical insurance company?
[CUSTOMER][NEUTRAL] Uh, no, actually, um, what I'm asking is, uh, for this one, you said that, uh, the claim will, uh, the office visit will not cover under the patient policy, right? So, can, uh, patient policy, so can be billed to the patient, uh, that's.
[AGENT][NEUTRAL] So billing to patient is asking, you're billing the responsibility to pay to the patient. So we don't determine patient responsibility because we're not a major medical insurance company. So at that point, it would be between you as the provider and primary. Since primary has already applied to the claim, you can see what your options would be as the provider. Do you write it off, do you bill the patient that would be up to your polic[PII]?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. Uh, OK. Can you please, uh, be on hold for a moment, so.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. Uh, thank you so much for patiently waiting, [PII]. And uh yeah, can we move to the next one?
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Mhm, I'm ready when you are.
[CUSTOMER][NEUTRAL] Oh yeah. Uh, the next member ID it's uh 024.
[CUSTOMER][NEUTRAL] 64745
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] No my my name is, it's uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] Uh, the date of service, it's uh [PII], and the total bill amount it's $197 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it'll be the same provider?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 3549831.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] OK, denied for the same reason, right? OK. Uh, can you please, uh, send an EOB?
[AGENT][POSITIVE] Yes, I'll be sending an explanation of benefits for all the claims we go over.
[CUSTOMER][NEUTRAL] OK, got it. And uh
[CUSTOMER][NEUTRAL] OK. Can we move to the next one?
[AGENT][NEUTRAL] Um, hold on one moment, I have to know each policy.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Uh yeah. Uh, the next member ID is 025.
[CUSTOMER][NEUTRAL] 13169.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] So my name is uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yeah, uh, the date of service it's [PII] and the total bill amount it's $241 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] I'm trying to receive the claim on [PII].
[AGENT][NEUTRAL] That claim number is 354.
[AGENT][NEUTRAL] 392 4.
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[AGENT][NEUTRAL] As office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] OK. Uh, denied on [PII], right?
[AGENT][NEUTRAL] Um, hold on one moment, let me.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It was received on [PII].
[AGENT][NEUTRAL] It was denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can we move to the next one?
[AGENT][NEUTRAL] Um, yes, give me just a moment. I'm noting the policy.
[CUSTOMER][POSITIVE] Yeah, sure, take your time.
[AGENT][NEUTRAL] And the next member's policy number?
[CUSTOMER][NEUTRAL] Uh, it's uh 02145412, M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you and the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] My my name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you for that and the data service and total bills.
[CUSTOMER][NEUTRAL] It's uh [PII]. And the total bill amount, it's uh $197 even.
[AGENT][NEUTRAL] Alright, I'm sure I receive that claim on [PII].
[AGENT][NEUTRAL] Claim number is 3550022.
[AGENT][NEUTRAL] And on [PII], the claim was denied as office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK. Got it.
[CUSTOMER][NEUTRAL] OK. Can we move to the next one?
[AGENT][NEUTRAL] Yes, I'll let you know when I'm ready. Hold on one moment, I have to note the policy.
[CUSTOMER][POSITIVE] Yeah, yeah. Take your time.
[CUSTOMER][NEUTRAL] Mm. Take your time, [PII], and, uh, as of now, how was your day going, [PII]?
[AGENT][POSITIVE] It's going well. How was yours?
[CUSTOMER][POSITIVE] Oh, sounds good.
[AGENT][NEUTRAL] All right, [PII], and the next member's policy number?
[CUSTOMER][NEUTRAL] It's 013.
[CUSTOMER][NEUTRAL] 697 54 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, the name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] And that was policy number 1369754?
[CUSTOMER][NEUTRAL] 136. Yes.
[AGENT][NEUTRAL] 9754 was correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, the reason I'm asking is because uh this is an individual policy, but the
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] Policyholder's name is different than what was provided. So your member is not on this policy. What was the first and last name?
[CUSTOMER][NEUTRAL] Uh, the first name is, it's, uh, OK, the insured is, OK, got it.
[CUSTOMER][NEUTRAL] Mhm. The patient's name is, uh, it's [PII]. Uh the first name [PII]. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the last name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] OK. For this one, can you please uh tell me the status about that?
[AGENT][NEUTRAL] So, as I advise, [PII] is not on this policy. It's an individual policy.
[AGENT][NEUTRAL] And [PII] is not the is not the policyholder. There's a different member's name on this policy, so there's no claim because there's no patient.
[CUSTOMER][NEUTRAL] OK, but actually, uh, he's, uh, uh, dependent on the artist [PII].
[AGENT][NEUTRAL] I understand what you're saying. What I'm explaining to you is this is an individual policy, meaning [PII] only is covered. [PII] is not on this policy. It's just the policyholder.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Can you please be on
[CUSTOMER][NEUTRAL] Can you please be on hold for a moment?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. Uh, for this one, you are saying that a claim is not on file, right? So because of [PII] is not a, um, uh, family member for this one, so that's why it is an individual policy, so that's why, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, can we move to the next one?
[AGENT][NEUTRAL] Yes, that's fine.
[CUSTOMER][NEUTRAL] Uh, the next member ID is, it's uh 018.
[CUSTOMER][NEUTRAL] 94936. M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] No, my name is [PII].
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[CUSTOMER][NEUTRAL] I
[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 members, um, I'm sorry, the date of service and the total bills?
[CUSTOMER][NEUTRAL] Date of service it's [PII] and the total bill amount it's $628 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment. Let me see if there's another policy.
[AGENT][NEUTRAL] OK, so the policy number that you provided um terminated on [PII].
[AGENT][NEUTRAL] There is an active policy.
[AGENT][NEUTRAL] Policy number 2569076.
[AGENT][NEUTRAL] That policy has been active since [PII]?
[AGENT][NEUTRAL] So I'm getting ready to pull that policy and see if the claim is there.
[AGENT][NEUTRAL] Is there a different total bill that the um claim could be or it's only the 628?
[CUSTOMER][NEUTRAL] Uh, it's $628 only.
[AGENT][NEUTRAL] OK, well, there's no claim on file um for the member for that data service.
[CUSTOMER][NEUTRAL] OK. Uh, actually, you are saying that this mem yeah, this member ID is inactive, uh, from [PII]. So from uh [PII], the patient has an updated ID that is 25696, right?
[AGENT][NEUTRAL] With that total bill.
[AGENT][NEUTRAL] 2569076. Yes, the phone went in and out.
[CUSTOMER][NEUTRAL] OK. Uh, can we, uh, bill, uh, now from this updated member ID?
[AGENT][NEUTRAL] Yes, there's no timely filing limit, so you can file the claim um as long as the policy was active and it was active on the data service.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Mm, OK. Can we move to the next one?
[AGENT][NEUTRAL] Um, yes, after I note the policy, give me just a moment.
[CUSTOMER][NEUTRAL] OK. Take your time and uh.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Oh yeah. Uh, the next member policy is, it's, uh,
[CUSTOMER][NEUTRAL] It's 1484263, M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] And that was 1484263?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] It's uh [PII] and the total bill amount is $1,474 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, so let me see if there's another policy.
[AGENT][NEUTRAL] Alright, so this policy um was, well, this policy terminated on [PII].
[AGENT][NEUTRAL] There is an active policy.
[AGENT][NEUTRAL] Um, as of [PII].
[AGENT][NEUTRAL] Policy number 230.
[AGENT][NEUTRAL] 4086.
[AGENT][NEUTRAL] I'm gonna look on that policy to see if there's a claim for you.
[AGENT][NEUTRAL] And the total bill was $1,474.
[CUSTOMER][NEUTRAL] Mm, yes.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Yeah, uh, can you please be on hold for a moment?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh yeah, please go ahead.
[AGENT][NEUTRAL] The policy number.
[CUSTOMER][NEUTRAL] The claim received on?
[AGENT][NEUTRAL] It was issued on [PII].
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 981 2.
[AGENT][NEUTRAL] And on [PII], uh, we paid out on the claim.
[AGENT][NEUTRAL] A total of $258.79.
[AGENT][NEUTRAL] Did you need the check information?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Oh yes, all right.
[CUSTOMER][NEUTRAL] Uh, actually, uh, we got received the payments, uh, from your end. It's, uh,
[CUSTOMER][NEUTRAL] It's 258.79. I'm having that details. But for the code 99214, we did not receive any uh payments from your end. Uh, it, it was denied as uh non-covered charges. So could you please tell me that information for the code, uh, for the CPT code [PII].
[AGENT][NEUTRAL] Right, the, the reason you gave was correct. Office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, office visit will not cover the policy. OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. Uh, for this one also, can you please, uh, send an EOB?
[AGENT][NEUTRAL] Yes, I'll be sending EOBs for all the claims we go over.
[CUSTOMER][NEUTRAL] OK. Can we move to the next one?
[AGENT][NEUTRAL] Um, give me just a moment. I have to know each policy. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] It's 1578878. M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] No my name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you for that and the data service and total bills.
[CUSTOMER][NEUTRAL] The date of service it's [PII] and the total bill amount it's $197 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Maybe
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] Claim number is 352-382-0.
[AGENT][NEUTRAL] And on [PII]
[CUSTOMER][NEUTRAL] OK. 352-3820, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied as office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, got it. And yeah. Can we move to the next one? This is the last one I'm on for the day.
[AGENT][NEUTRAL] Hold on one moment while I note the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, the next member's policy number?
[CUSTOMER][NEUTRAL] The next member policy number is 87.
[CUSTOMER][NEUTRAL] 24456.
[AGENT][NEUTRAL] Is that the group number or the policy number?
[CUSTOMER][NEUTRAL] Uh, actually, in my, it's, uh, number, yeah.
[CUSTOMER][NEUTRAL] There's no policy number.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, it is a policy number only, group number and also policy number.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] May I have the member's first and last name?
[CUSTOMER][NEUTRAL] The first name is, it's uh
[CUSTOMER][NEUTRAL] It's uh [PII]'s [PII].
[AGENT][NEUTRAL] And what's the last name?
[CUSTOMER][NEUTRAL] It's [PII]. It's uh [PII].
[AGENT][NEUTRAL] Wait, wait, I'm sorry, I'm sorry. Hold on one moment. Hold on one moment. Can you spell the, can you spell the last name again?
[CUSTOMER][NEUTRAL] [PII] is
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] sorry, [PII].
[AGENT][NEUTRAL] OK, hold on one moment, I found it.
[CUSTOMER][NEUTRAL] [PII] and also [PII], the last one. [PII].
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify her date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK. So the policy, uh, well,
[AGENT][NEUTRAL] The most recent policy number is 216.
[AGENT][NEUTRAL] 8644.
[AGENT][NEUTRAL] And may I have the date of service for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] Uh, it's [PII]. And the total bill amount it's $479 even.
[AGENT][NEUTRAL] OK, let me go to the other policy. Hold on one moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Actually, I'm having a special concern about this claim.
[AGENT][NEUTRAL] And you said it's $479?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What's the claim number that you have?
[CUSTOMER][NEUTRAL] Actually, I'm not having a claim number here.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] This is the same claim number.
[AGENT][NEUTRAL] OK. So I just located the claim, um, you said you have a specific question?
[CUSTOMER][NEUTRAL] Yes. Actually, uh, we have received the payment for 11104 CPT code. And uh for 99213, the claim was denied as uh non-covered charges. So could you please tell me the exact reason why it was denied and when it was received the claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Offices
[AGENT][NEUTRAL] Office visits are not covered by the policy?
[AGENT][NEUTRAL] And we received the claim.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] OK. What is the claim number?
[AGENT][NEUTRAL] 354.
[AGENT][NEUTRAL] 9691.
[CUSTOMER][NEUTRAL] OK, got it. And uh yeah. Um.
[CUSTOMER][NEUTRAL] OK. Uh, can you please uh tell me the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date. First initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK. Your name.
[CUSTOMER][NEUTRAL] OK, got it. OK. Can you please uh send this all your bits to uh fax?
[AGENT][POSITIVE] Yes, again, I'll be sending all these to you. I'm sending them to you now. Um, so you should be receiving them, we say an hour at the most. If you have not received them um by the end of day today, just give us a call and we'll be more than happy to resend them.
[CUSTOMER][POSITIVE] OK. Got it. And uh thank you so much for your assistance. And uh that's it for the day, [PII].
[CUSTOMER][NEUTRAL] Bye for now.
[AGENT][POSITIVE] Thank you, [PII]. Well, thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Bye bye.