AccountId: 011433970860
ContactId: a2115bad-dd44-42fe-ab1b-a19ba86969a4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 470049 ms
Total Talk Time (AGENT): 168047 ms
Total Talk Time (CUSTOMER): 186295 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/a2115bad-dd44-42fe-ab1b-a19ba86969a4_20250502T19:24_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, I wanted to um uh get information on this claim.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you on your claim. May I have your name?
[CUSTOMER][NEUTRAL] Sure. It's [PII]
[AGENT][NEUTRAL] And [PII], may I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] Sure, it's [PII]. I'm calling from provider's office.
[AGENT][NEUTRAL] OK, you're a provider. OK, and may I have the
[CUSTOMER][NEUTRAL] Do you need the number?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah, the member's ID number is, excuse me, 01994048 M as in Mike, L as in Lima 8.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Um, [PII] and [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And what is the claim number for the claim we have questions on today?
[CUSTOMER][NEUTRAL] I don't have the claim number. Um, I do have the same date and bill them out.
[AGENT][NEUTRAL] OK, and I'll take the data service and the total bills whenever you're ready.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 3 14 2025 and the charge of the bill amount is 1210.
[AGENT][NEUTRAL] And did you say 3-13 of 2025?
[CUSTOMER][NEUTRAL] 314 314 25.
[AGENT][NEUTRAL] OK, and it was $1,205?
[CUSTOMER][NEUTRAL] 1210.
[AGENT][NEUTRAL] OK, sorry about that. The phone's breaking up here. Hold on one moment. $1210?
[CUSTOMER][POSITIVE] That's correct, yeah.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And what is the name of the facility?
[CUSTOMER][NEUTRAL] Atkins spine and pain medicine.
[AGENT][NEUTRAL] OK, so we do have a claim on file from you all, but it's a different total billed. Um, could it be any other total bills?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That's what I have here.
[AGENT][NEUTRAL] What's your tax ID?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so it's the same, um,
[AGENT][NEUTRAL] Tax ID, the total bills on this um claim that we have is $300. So if this, if it
[AGENT][NEUTRAL] That's the only one for that data service. So if it's not this one, then we don't have your claim on file.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm not sure because it goes um it goes um automatically, so the primary um insurance had probably um sent it over, or how, I don't know how it works, crossed it over somehow. Um, but that was the original.
[AGENT][NEUTRAL] What's the procedure code?
[CUSTOMER][NEUTRAL] So we have here.
[CUSTOMER][NEUTRAL] I have 4, so.
[CUSTOMER][NEUTRAL] 5, 9921399512.
[CUSTOMER][NEUTRAL] 27096
[CUSTOMER][NEUTRAL] Um, J 1010 and then Q 9966.
[AGENT][NEUTRAL] OK, so you'll have to submit your claim. Um, the the claim that we have here only has one code and that's 99213.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] Right. Might have been because um I see that the primary had broken it down into two claims. Is that um.
[CUSTOMER][NEUTRAL] That was
[CUSTOMER][NEUTRAL] I have that 99213 $300 a lot amount was $75.86.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is that correct? And then the paid one was $25.83 86 cents, sorry.
[AGENT][NEUTRAL] Yes,
[CUSTOMER][NEUTRAL] So then I have another.
[AGENT][NEUTRAL] So we only
[CUSTOMER][NEUTRAL] Yeah. Go ahead.
[AGENT][NEUTRAL] So we only have one claim on file for this data service, um, which is the, the claim that has a 99213, but it was denied because office visits are not covered on this policy. Um, there's no timely filing limit, so you can file the claim if you'd still like to. The policy was active on the data service, but we only have this one claim on file for this data service.
[CUSTOMER][NEUTRAL] OK, uh, so question, you said it was denied because it was not active on the data server?
[AGENT][NEGATIVE] Um, it was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Oh, OK, OK, so 99213 is not for it, um, but the rest of the procedure code should be covered.
[CUSTOMER][NEUTRAL] So, um, so you didn't receive any other claim cause I see over here that the, the primary had um processed the, the other claim. I don't know if you would have the, the claim number. If I could give it to you, maybe you can look it up that way. Um, E as in echo. Yeah.
[AGENT][NEUTRAL] No, no, hold on, hold on one second. No matter what the claim number is, when I put the date of service, every claim with that data service will populate and we only have one. So you can submit this claim if you'd like for us to process it for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, um, so just resubmit it again basically.
[AGENT][NEUTRAL] Yes, um, the, the one that you have with all five claims, because we only have the one with the 99213 that was the 9.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Um, and everything else is correct, um, in terms of eligibility and
[CUSTOMER][NEUTRAL] Because over here our notes say that non-provider non-purchasing provider at time of service that's what it says over here, the note that we have.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] No, this
[AGENT][POSITIVE] No, the policies were active. Um, these policies have been effective.
[AGENT][NEUTRAL] Well, this particular one has been effective since [PII], um, and it's still active now.
[CUSTOMER][NEUTRAL] OK, got it. Um, can I just get your name and reference number, please?
[AGENT][NEUTRAL] Sure, my name is [PII].
[AGENT][NEUTRAL] And was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] And then whenever the reference number.
[AGENT][NEUTRAL] So there's no call reference number, you can use my name and today's date?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][POSITIVE] All right, thank you so much have a good day.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.