AccountId: 011433970860
ContactId: 9c5f293a-9aca-44be-9382-e37bbf69d1a1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 614500 ms
Total Talk Time (AGENT): 136491 ms
Total Talk Time (CUSTOMER): 186646 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/9c5f293a-9aca-44be-9382-e37bbf69d1a1_20250414T19:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, [PII]. This is [PII] calling for provider to check on additional information about the claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes.
[AGENT][NEUTRAL] Yes, [PII], do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, just one.
[CUSTOMER][NEUTRAL] The policy number is 02473025 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then what's a good call back number in case our call gets dropped?
[CUSTOMER][NEUTRAL] Just callback number is [PII]. It's a direct line.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then the patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the patient name is uh [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you're just checking on a claim. Do you have the um the sorry, the data service and the charge amount by chance?
[CUSTOMER][NEUTRAL] D of service [PII].
[CUSTOMER][NEUTRAL] That's for the total charge amount of $679 even.
[AGENT][NEUTRAL] OK, and the date of service, what was the, uh, month?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] And the bill amount is $83 679 dollars even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so it looks like the received date was [PII].
[AGENT][NEUTRAL] The process date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this claim was denied because office visits are not covered.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Not covered as for the patient plan?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEGATIVE] They're not covered under this policy.
[CUSTOMER][NEUTRAL] OK. And the
[CUSTOMER][NEUTRAL] And the patient plan type?
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] So it looks like the patient has a medlink policy.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Meddling
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much. So the claim number is 356-0910.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] I do have one more claim, [PII]. Could you please help me with that?
[AGENT][NEUTRAL] Yes, of course. Is this for a different patient?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, just one moment.
[CUSTOMER][NEUTRAL] OK the call reference for this one.
[AGENT][NEUTRAL] OK. And then what's the policy number for the next one?
[CUSTOMER][NEUTRAL] OK. The next one, the policy number is 016176.
[CUSTOMER][NEUTRAL] 05 M as in Mike, L as in Lima, 8.
[AGENT][POSITIVE] Perfect. Thank you.
[AGENT][NEUTRAL] OK. The patient's first and last name and then date of birth.
[CUSTOMER][NEUTRAL] Yeah, the patient name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK. And do you have the claim number for that one?
[CUSTOMER][NEUTRAL] Uh, yes, I do have a claim number one moment.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Claim number
[CUSTOMER][NEUTRAL] Um, no, I don't have a, one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the claim number is 354-9250.
[AGENT][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] OK, so I'm not seeing that claim number for this policy.
[AGENT][NEUTRAL] Uh, do you have a data service and a charge amount?
[CUSTOMER][NEUTRAL] Uh, data service [PII].
[CUSTOMER][NEUTRAL] For the charge amount of $1,352.55.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do not have a claim on file for that data service either as of right now.
[CUSTOMER][NEUTRAL] [PII], you don't have a 2024, you don't have a claim?
[AGENT][NEUTRAL] No, there is, there is not one.
[CUSTOMER][NEUTRAL] Uh, the claim number 354-9250.
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 354-925-009.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] This is for patient [PII], right? Uh, this is for different tax ID.
[CUSTOMER][NEUTRAL] Did you change the tax ID NPI?
[AGENT][NEUTRAL] Yes, I did. This is for [PII], right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, for policy.
[CUSTOMER][NEUTRAL] And the provider is Palm Beach.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, it's policy 1617605.
[CUSTOMER][NEUTRAL] 161760511?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, no, uh, the policy number.
[CUSTOMER][NEUTRAL] 01617605
[CUSTOMER][NEUTRAL] M as in Mike, L as in Lima, number 8.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, and this is a provider Palm Beach Orthopedic Institute.
[AGENT][NEUTRAL] Sorry, what was that?
[CUSTOMER][NEUTRAL] Provider's name, uh Palm Beach Orthopedic Institute. Did you change that NPI?
[CUSTOMER][NEUTRAL] NPI 1184796245.
[AGENT][NEUTRAL] You said 11874.
[CUSTOMER][NEUTRAL] No, no. 1184796245.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] See, just one moment.
[AGENT][NEUTRAL] No, I'm still not seeing that claim on file.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. Uh, to resubmit this claim, the claim mailing address?
[CUSTOMER][NEUTRAL] Claim mailing address is that the [PII].
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Uh, the timely filing limit to submit a claim.
[AGENT][NEUTRAL] No, there is no filing limit.
[CUSTOMER][POSITIVE] Thank you so much. And the call reference, call reference for the first one.
[AGENT][NEUTRAL] Yes, it is [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] My last initial [PII] and then today's date.
[CUSTOMER][POSITIVE] OK, [PII], thank you so much and uh have a wonderful day. Take care, bye.
[AGENT][POSITIVE] Thanks, is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's it. Thank you. Bye.
[AGENT][POSITIVE] OK. Yes, thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Mhm.