AccountId: 011433970860
ContactId: af1112ca-b925-4ea9-92ef-b92d51b98e07
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 460459 ms
Total Talk Time (AGENT): 172794 ms
Total Talk Time (CUSTOMER): 135606 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/af1112ca-b925-4ea9-92ef-b92d51b98e07_20250414T15:17_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]. This is [PII] calling from provider's office, checking on claims.
[AGENT][POSITIVE] Hi [PII], I'll be more than happy to assist you with the claims and how many claims do you have today?
[CUSTOMER][NEUTRAL] I just have one.
[AGENT][NEUTRAL] Alright, and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, that is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02455544.
[AGENT][NEUTRAL] Thank you, 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] [PII] for date of birth, [PII].
[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 date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Sure, that's [PII] and total bill amount is $1250.57.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Florida Foot and Ankle Associates LLC.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I'm trying to received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 3577021.
[AGENT][NEUTRAL] And on [PII], um, well, it's several reasons. Code 99203 was denied because office visits are not covered on this policy.
[AGENT][NEUTRAL] All other codes were denied um because benefits are payable only if major medical provides benefits. If the claim is later paid by major medical, just provide the explanation of benefits showing they paid and we will be um able to reprocess.
[CUSTOMER][NEUTRAL] OK, so, uh, do you have like, uh, the claim was initially processed by Blue Cross Blue Shield of Florida that, uh, you are requesting for the primary EOB for that one, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. So do you have the primary OB for [PII] claim? Because uh from Blue Cross Blue Shield, we see that the claim was merged and processed for the date of service [PII] and [PII]. So can you check if in the same year you have the date of service [PII] as well?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This really isn't even an explanation of benefits. This is more like a remittance from floor to foot and ankle, but on here, it only shows October.
[AGENT][NEUTRAL] What is that?
[AGENT][NEUTRAL] This shows [PII].
[AGENT][NEUTRAL] And it also has
[CUSTOMER][NEUTRAL] No, and the date of birth mhm.
[AGENT][NEUTRAL] I mean, I see [PII] on here, but on everything it shows zeros as if they haven't submitted anything to it. So that's why we're asking for the explanation of benefits.
[AGENT][NEUTRAL] From the primary insurance for just this data service so that we can see what they submitted because everything has zeros here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And uh the code 99203, that was denied. Can you please repeat that uh
[AGENT][NEUTRAL] Mhm. 99203 was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] The Nile region.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, by patient's policy or provider policy?
[AGENT][NEUTRAL] Um, by patient's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So you want the primary you will be for rest, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Because the amount of which is showing to you under the [PII], date of service is all zero paid.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, sure, we can send that to you. Could you please help me with your fax number?
[AGENT][NEUTRAL] Yes, um, so it's [PII].
[AGENT][NEUTRAL] I'm sorry, I'm getting ready to give you our phone number. It's [PII], I'm sorry, [PII].
[AGENT][NEUTRAL] [PII] 3.
[CUSTOMER][NEUTRAL] [PII]. And do you have a timely filing limit for that?
[AGENT][NEUTRAL] Um, no timely filing as long as the policy is active on the data service, you can file the claim at any time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you so much for that and do you want, uh, what attention should we add when we are submitting this EOB, the primary EOB?
[AGENT][NEUTRAL] Um, so that's attention APL claim department.
[CUSTOMER][POSITIVE] OK. Thank you so much for that and uh call reference for our call today, please.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date and that's [PII].
[CUSTOMER][POSITIVE] OK, thank you so much for assisting [PII]. Have a great one. Bye bye.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, so we don't have any specific form to be attached, right, when we are sending the primary EUB to you.
[AGENT][NEUTRAL] Um, no, sometimes the providers send it over like with your claim form, but even if you just send the explanation of benefits by itself, that's fine because it's additional information, so we'll know we asked for it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you. Thanks for assisting [PII] bye bye.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. Have a great week.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye bye.