AccountId: 011433970860
ContactId: aa2b25af-9c2f-4a56-8704-3bb5e29450d4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 519859 ms
Total Talk Time (AGENT): 218893 ms
Total Talk Time (CUSTOMER): 203300 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/aa2b25af-9c2f-4a56-8704-3bb5e29450d4_20250203T16:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling for Doctor [PII]. Please note this call will be monitored and recorded for quality and training purposes. I'm calling to check on the claim status, and you said your name is [PII], right?
[AGENT][POSITIVE] Right, [PII], and I could definitely check on a claim for you, [PII]. Uh, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, of course. The callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] and it's a direct line.
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yep, of course. The policy number is going to be 024.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 94959
[AGENT][NEUTRAL] All right. Thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Yes, of course. The name of the patient is going to be [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Alright, thank you for verifying all of that, [PII]. uh, so for this policy I am unable to view uh claim information as that is going to be handled through they're called web TPA. I can give you that phone number, uh, and then I can transfer you to them if you'd like.
[CUSTOMER][NEUTRAL] Oh, the claim was handled by web TPA. May I know why the, uh, webTPA handled this claim?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Uh, it's just a specific kind of policy, um, some of them are just handled through them, others we're able to view. I think it's the preference of the employer.
[CUSTOMER][NEUTRAL] Oh, all right. And may I have the contact number?
[AGENT][NEUTRAL] Yes, so their phone number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Perfect. Uh, so if you don't mind, I do have another claim. It's under a different patient. Once after getting the call reference number, shall we check with that patient here?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We can, yes, um, so the reference number would be the same for all of them um they would just be my first name, last initial, and today's date, um, so my last initial is A.
[CUSTOMER][POSITIVE] Perfect. Thank you so much, [PII].
[AGENT][NEUTRAL] OK, one moment and then I will be ready for that next policy number.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][POSITIVE] Yes, of course.
[AGENT][NEUTRAL] OK, I am ready for that policy number T.
[CUSTOMER][NEUTRAL] Thank you. The next policy number is 018.
[CUSTOMER][NEUTRAL] 225
[CUSTOMER][NEUTRAL] 28, M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Alright thank you and then what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] The patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Alright, thank you for verifying that [PII]. uh, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Yes, of course. The date of service is going to be
[CUSTOMER][NEUTRAL] OK. So that's [PII]. And the bill amount is $655.95 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that was [PII] for $655.95.
[CUSTOMER][POSITIVE] You're right.
[AGENT][POSITIVE] Got it OK thank you one moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] So I did find a claim was the $548.84. Was that the remaining balance after major medical?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I just found here that it's $70. Just a minute, I will double check from my end.
[AGENT][NEUTRAL] That's OK. um, if you wouldn't mind actually, could you verify the uh tax ID for the provider?
[CUSTOMER][NEUTRAL] Yes, of course. The tax ID is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so this is the only claim that I received for this date of service, [PII], and it is from that provider, the Hand Institute, um, it's for the amount of $548.84. Um, if you like I can verify that, uh, procedure code we make sure that we're looking at the same claim.
[CUSTOMER][NEUTRAL] Uh, one moment. I will double check in the claim form for the bill amount. Just a moment, please.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You said it's $548.64 right?
[AGENT][NEUTRAL] Uh, 84.
[CUSTOMER][NEUTRAL] 84. I do find it's 54864. 1 moment. I will double check in the primary, primary. Oh, so primary claim form found 65595. And the secondary claim.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Sorry, secondary claim form uh shows 548.64 84.
[AGENT][NEUTRAL] OK, OK, it might just be a little mistake on our system, um, so that, but this is for procedure code 99204 correct?
[CUSTOMER][NEUTRAL] One moment. Procedure code 99204. You're right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Perfect. OK, OK, yes, I do see that it's 54864. It looks like it might have just been mistyped in our system, um, so for this clientina we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So may I know the received date of the claim?
[AGENT][NEUTRAL] Absolutely, give me just a moment. So this claim was received [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] OK. So the claim was denied for non-covered charges as patient plan or the provider plan?
[AGENT][NEUTRAL] Uh, for the patient's plan, it's the offices that they're just not covered under this policy.
[CUSTOMER][NEUTRAL] As per patient plan.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. For documentation purpose, may I know the appeal mailing address?
[AGENT][NEUTRAL] Yes, our mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK. And may I know the timely filing limit to submit an appeal?
[AGENT][NEUTRAL] Uh, that is gonna be within 180 days of the process date.
[AGENT][NEUTRAL] And if you'd like, [PII], I can send you a copy of this uh EOB. Do you have a fax number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, no problem. It's fine. Thank you so much for your confirmation. Just a moment. Uh, so the procedure code of 99204.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We'll do that.
[CUSTOMER][POSITIVE] Thank you so much for your patience and uh there is no duplicate claim on file, right?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Correct, this is the only claim that we received for that date of service.
[AGENT][NEUTRAL] Uh, did you need this claim number, [PII]? Of course, yes, right, so that is 353-763-0.
[CUSTOMER][NEUTRAL] OK. May I know the claim number?
[CUSTOMER][POSITIVE] Yes, you're right.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 353-763-0, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][POSITIVE] Perfect. And you already confirmed that your name and the status of call reference. Perfect. Thank you so much for your assistance. Have a lovely day, [PII]. Take care.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.