AccountId: 011433970860
ContactId: acc1967f-7c96-459b-b119-b25946867a91
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 614260 ms
Total Talk Time (AGENT): 261822 ms
Total Talk Time (CUSTOMER): 209879 ms
Interruptions: 0
Overall Sentiment: AGENT=2.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/acc1967f-7c96-459b-b119-b25946867a91_20250109T15:35_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from doctor office checking for clients.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with some claims today, [PII], and can I please get a good call back number?
[CUSTOMER][NEUTRAL] Yes, the callback number is [PII], and it's the direct line?
[AGENT][NEUTRAL] Thank you, sir. And what is that policy number we're looking at today?
[CUSTOMER][NEUTRAL] Yeah, the policy number starts with number 0143266 followed by the letter M as in Mike, L as in Lima, and the number 8.
[AGENT][NEUTRAL] And you said 0143266, is that correct?
[CUSTOMER][NEUTRAL] Yes, 3266 ML 8.
[AGENT][NEUTRAL] OK, so I actually don't have a policy pulling up with that ID number. It looks like it's a digit short.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 123456.
[AGENT][NEUTRAL] Um, I can try searching if you'd like with the patient's first and last name.
[CUSTOMER][NEUTRAL] Yeah, sure. The patient's first name is uh [PII].
[CUSTOMER][NEUTRAL] And the last name is [PII].
[AGENT][POSITIVE] OK, yeah, and can you spell those for me pretty please?
[CUSTOMER][NEUTRAL] Yeah, sure. The first name starts with letter [PII]. The last name begins with [PII].
[AGENT][POSITIVE] Perfect, thank you so much and give me a moment to work on that for you.
[CUSTOMER][NEUTRAL] Sure. Uh, can you please spell your name for document purpose?
[AGENT][POSITIVE] Yes, absolutely. It's [PII], [PII].
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] My pleasure.
[AGENT][POSITIVE] All right. And I do believe I was able to find her right here, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Could you verify for me her date of birth, please?
[CUSTOMER][NEUTRAL] Yes, sure. It's [PII].
[AGENT][POSITIVE] Thank you so much. And the number I had was really similar. I think maybe I typed it wrong or misheard you, but I had 01432669, and I was missing the 9 on the end of mine.
[CUSTOMER][NEUTRAL] The people
[CUSTOMER][NEUTRAL] Uh, actually, uh, after, uh, 66 it has been updated as EML 8. So here is the mistake happened. So the number starts, uh, ends with 9 right after 2266.
[AGENT][NEUTRAL] Yes, absolutely, yeah, if you want to update that for your notes as well, my friend, and are you wanting to get clarification on a claim status you've already received and you have that claim number or are you needing me to search for your claims today?
[CUSTOMER][POSITIVE] Yes, I will.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] No, I, no, I, I need to search for the claim because I this is the first time I'm calling for this station.
[AGENT][NEUTRAL] No worries. What's the data service we wanna look at for her?
[CUSTOMER][NEUTRAL] Yeah, I'm looking for number 26 of 2024 with the total bill amount of $292.89.
[AGENT][POSITIVE] OK, perfect. Give me just one second and I'll start looking for that for you.
[CUSTOMER][NEUTRAL] Yeah, sure, [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] All right, and can you verify for me pretty please the name of the provider's office or the facility name on file?
[CUSTOMER][NEUTRAL] Yeah, sure, I'm calling on our behalf of Barnet Dermatology.
[AGENT][POSITIVE] Wonderful, perfect, and I did find that claim right here for you. I'm looking at claim number 354.
[AGENT][NEUTRAL] 8039.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm showing we've received the claim on [PII], and the claim was processed on [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I am showing that claim is denied. I have two denial codes that I can read for you. The first one is stating that office visits are not covered by the above numbered policy, and that is going to be on procedure code 99213.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then the next ones say that the outpatient benefit for this calendar year have been met and those are gonna be on the other two codes for the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Out patient benefits were not.
[CUSTOMER][NEUTRAL] OK, just let me have an update on the 5.
[AGENT][NEUTRAL] And are you needing me to send you a copy of that EOB, sir?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] OK, perfect. Let me pull it up real fast.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For your EOBs, do you want them, uh, sent out attention to yourself, or do you want them sent out attention to the patient account number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Is that possible to send through fax, Ali?
[AGENT][POSITIVE] Yeah, I can fax them you bet you.
[CUSTOMER][NEUTRAL] Yes, sure, you can send under my name.
[AGENT][POSITIVE] Perfect, [PII] and what is the um fax number to send to?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah, the fax number is [PII].
[AGENT][NEUTRAL] I have [PII].
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][POSITIVE] Perfect. I'm gonna send on that right now for you, [PII]. You should see it come through in about 5 to 15 minutes. And is there anything else for this claim that I can help you on?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Yeah, uh,
[CUSTOMER][NEUTRAL] I need to know some more information regarding this claim. Ali. Uh, may I know, uh, if the provider is contract provider or non non-pering provider?
[AGENT][POSITIVE] And I'm so sorry, can you just restate your question for me? I wanna make sure I answer it right.
[CUSTOMER][NEUTRAL] Yeah, I would like to know if there is we are participating or non-participating provider for this.
[AGENT][NEUTRAL] Oh, OK, yeah, so what we do is we follow the major medical where there's secondary gap insurance, so we just kind of do, we follow whatever major medical does.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, uh, is there any possibility that we can submit this claim through medical record to be able to process the claim?
[AGENT][NEUTRAL] Um, so we can't submit it for reprocessing, but you do have the right to appeal. You have 180 days, um, from the, the [PII], the day it was denied, to make an appeal if you'd like.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure, uh, can you please provide me the mailing address?
[AGENT][NEUTRAL] The appeal mailing address? Yeah, I absolutely can. Let me pull it up.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, and if you are wanting to appeal, you'll need to send a letter of appeal and that's gonna go to um attention appeal department.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it's gonna come to our [PII], that's in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Our zip code here is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh [PII], right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's [PII], right?
[AGENT][NEUTRAL] Uh, close. The [PII].
[CUSTOMER][NEUTRAL] [PII] just let this thing [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, yeah, just.
[CUSTOMER][NEUTRAL] Yeah, I got it, uh,
[CUSTOMER][NEUTRAL] Yeah, OK. So may I know the processing limit for this? I mean, uh, how long it will take time to process the claim.
[AGENT][POSITIVE] OK, yes, absolutely. Let me, I'm so sorry, I just left that screen.
[AGENT][NEUTRAL] Alright, so they say that um appeals can take up to 30 days to render a decision.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 1 is 30 days according to the rendering, right.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] If according to the returning.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] Yes, sure, thank you.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] Uh, yes, so, yes, uh, [PII], and thank you for the information. Can I have the reference number for this call?
[AGENT][NEUTRAL] Yeah, the call reference number is just my name [PII], first initial, last name, [PII], and today's date.
[CUSTOMER][POSITIVE] Yeah, thank you [PII]. Thank you for the information you have and have a wonderful day.
[AGENT][POSITIVE] Hey thank you [PII] you take care and you have a great day as well.
[CUSTOMER][POSITIVE] Yeah yeah thank you bye.
[AGENT][POSITIVE] My pleasure. Bye-bye.