AccountId: 011433970860
ContactId: bcf9b875-3b43-4bda-a937-165df920dce7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 683900 ms
Total Talk Time (AGENT): 128416 ms
Total Talk Time (CUSTOMER): 132091 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/bcf9b875-3b43-4bda-a937-165df920dce7_20250425T19:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from the doctor's office to check on a claim denial reason.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, that is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And policy number of the patient?
[CUSTOMER][NEUTRAL] The policy number is 022.
[CUSTOMER][NEUTRAL] 84511.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] His name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] And date of service and bill charges?
[CUSTOMER][NEUTRAL] [PII] and the total charge is $104 even.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] Um, looks like this policy terminated [PII]. Let me see if there's an active policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yes, there's an active policy. The policy number you gave me was an old one. So let me get that pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what were the bill charges?
[CUSTOMER][NEUTRAL] I'm sorry, the $104 even?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I don't they filed it under the other old policy, so let me go back to that one. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have a claim number?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, I'm just making sure.
[AGENT][NEUTRAL] OK, yeah, I don't, I don't show the claim on file. So let me give you the new policy number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 257
[AGENT][NEUTRAL] 881 9.
[CUSTOMER][POSITIVE] OK, thank you, and I do have one more client for your kind assistance for different patients.
[AGENT][NEUTRAL] OK, uh, let me make a note real quick and then I'll be able to look that up. Hold on one moment.
[CUSTOMER][POSITIVE] Take your time, OK.
[AGENT][NEUTRAL] OK, and what is that policy number?
[CUSTOMER][NEUTRAL] That's 126-5678.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And then what was that date of service and bill charges?
[CUSTOMER][NEUTRAL] The service is [PII] and the total charges.
[CUSTOMER][NEUTRAL] And hold on.
[CUSTOMER][NEUTRAL] For $41.31.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] OK, looks like we received it a few times. Let me see which one.
[AGENT][NEUTRAL] Which one's right?
[CUSTOMER][NEUTRAL] Uh, you can go, go with the latest one.
[AGENT][NEUTRAL] OK, is that 358-860-3, is that what you have?
[AGENT][NEUTRAL] Or you don't know the claim number? OK, let me look at.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] That's a duplicate.
[AGENT][NEUTRAL] OK, so that.
[AGENT][NEUTRAL] All payable benefits were applied to policy deductible.
[CUSTOMER][NEGATIVE] Yeah I do see the code 87038 was denied.
[AGENT][NEUTRAL] Uh, does this item does not meet the definition of durable medical equipment under the policy contract?
[CUSTOMER][NEUTRAL] Could you please repeat that?
[AGENT][NEGATIVE] Uh, item does not meet the definition of durable medical equipment under policy.
[CUSTOMER][NEUTRAL] So is it not covered under the patient policy or?
[AGENT][POSITIVE] Uh, correct.
[CUSTOMER][NEUTRAL] So is there a patient responsibility for the procedure A 7038?
[AGENT][NEUTRAL] Uh, we don't determine patient responsibility as a secondary policy.
[CUSTOMER][NEUTRAL] I got it.
[CUSTOMER][NEUTRAL] So, but as for the patient policy, the procedure A703A is not 838 is not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So just give me a moment. Let me verify whether we have received any previous payment for the same procedure.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] One more moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh number 10
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Can you double-check whether we, whether uh any other payment has been received for this patient for the same procedure?
[AGENT][NEUTRAL] Um, I, I would have to know like the date of service. Um, I can't search by code, but I can tell you this is for a disposable piece of equipment.
[AGENT][NEUTRAL] And the durable medical equipment definition does not cover anything disposable.
[CUSTOMER][NEUTRAL] I got it.
[AGENT][NEGATIVE] So it can't, can't be disposable.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so I don't see any payment for the same position.
[CUSTOMER][NEUTRAL] Can I have, uh, do we have a fax number for a few?
[AGENT][NEUTRAL] Fax number is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, attention to?
[AGENT][NEUTRAL] Uh, peels.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] What is the time limit?
[AGENT][NEUTRAL] For appeals
[CUSTOMER][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] 180 days from processed date.
[CUSTOMER][NEUTRAL] Can I have the recent and the last processed claim number?
[AGENT][NEUTRAL] Of the what?
[CUSTOMER][NEUTRAL] The claim number?
[AGENT][NEUTRAL] The claim number is 3567864.
[CUSTOMER][NEUTRAL] And your name is?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, [PII], thank you. Have a good day. Bye for now.
[AGENT][POSITIVE] Thanks for calling APL.