AccountId: 011433970860
ContactId: be8697c7-7aca-45b7-b0b9-3e3818a7353b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1410199 ms
Total Talk Time (AGENT): 382856 ms
Total Talk Time (CUSTOMER): 656335 ms
Interruptions: 6
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/be8697c7-7aca-45b7-b0b9-3e3818a7353b_20250416T13:47_UTC.wav
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[AGENT][POSITIVE] Good Morning, thank you for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling for Access Medical Clinic Kansas LTC LLC. Please be informed that this call is being recorded and monitored for the quality and training purposes. I verified that you will be and this call is made for the additional information about the denial [PII].
[AGENT][NEUTRAL] OK, you're needing information regarding a denial on a claim, is that correct?
[CUSTOMER][POSITIVE] Yes, yes, crazy, correct.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your name again?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] I'm sorry, can you spell your name for me, please?
[CUSTOMER][NEUTRAL] Yeah, sure. [PII], and that's uh uh my last name initial will be [PII]. OK.
[AGENT][NEUTRAL] OK, so thank you and your callback number please?
[CUSTOMER][NEUTRAL] OK, it's [PII], which is a direct line.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Thank you and the member's policy number [PII].
[CUSTOMER][NEUTRAL] OK, the member's policy number will be 02.
[CUSTOMER][NEUTRAL] 5856551
[AGENT][NEUTRAL] Thank you one moment while I get the member's information pulled up please.
[CUSTOMER][POSITIVE] Yeah, sure, no problem, take your time.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] In finding the information that I do provide today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK. The name of the patient is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][POSITIVE] Uh, no problem, take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total amount is $289.20.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][POSITIVE] Mhm. No problem.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and do you already have the claim number?
[CUSTOMER][POSITIVE] Yes, I do.
[CUSTOMER][NEUTRAL] Should I provide you that?
[AGENT][NEUTRAL] And that claim number should, it should be 3584727. Is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK. So yes, I do see on this claim there was a $75 benefit issued.
[AGENT][NEUTRAL] And the remarks.
[CUSTOMER][NEUTRAL] Yeah, but uh that code is paid. I'm checking only for the code, first of all, sorry for interrupting. I'm checking only for the code G as in Golf 2211.
[AGENT][NEUTRAL] Yes, it states
[CUSTOMER][NEGATIVE] 75 uh it's paid in 99203, not for this code.
[AGENT][NEUTRAL] OK, the G2211 was denied as the maximum benefit payable for this state of service has been met.
[CUSTOMER][NEUTRAL] OK. So maximum benefit payable. OK.
[AGENT][NEUTRAL] For this state of service has been met. That was met with that $75 payment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Payable.
[CUSTOMER][NEUTRAL] Has been met.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so the code will be paid only one time, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And if you need a copy of this EOB, uh, so then you can print out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the allowed units for this?
[AGENT][NEUTRAL] $75. This is a limited benefit plan and that is the maximum amount payable for this data service.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits, you should be able to print that by going to our portal which is located at [PII].
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, then. Thank you so much for that. And could you please go ahead and provide the timely filing limit for it, is it 180 days from the date of Saturday night?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] An appeal must be filed within 180 days from the date of the denial. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. Could you please go ahead and provide the received and deny it?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Again, the date of the process date.
[CUSTOMER][NEUTRAL] Mm yes.
[AGENT][NEUTRAL] This claim was processed on.
[AGENT][NEUTRAL] [PII] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] And when did you receive this claim, please?
[AGENT][NEUTRAL] It was received on [PII].
[CUSTOMER][NEUTRAL] Thank you so much for that. And could you please go ahead and verify the mailing address that is [PII] [PII].
[AGENT][NEUTRAL] Yes ma'am. Attention appeals department.
[CUSTOMER][NEUTRAL] OK, thank you so much for that. Could you please go ahead and provide the call reference number before moving to the next claim?
[AGENT][NEUTRAL] How many claims do you have?
[CUSTOMER][NEUTRAL] Um, more 3.
[AGENT][NEUTRAL] You have 3 more.
[CUSTOMER][NEUTRAL] Um, yeah, please.
[AGENT][NEUTRAL] OK, you will use my name and today's date as your call reference number for all of them, and any information provided on any claim will be a verification of benefits and not a guarantee of payment, and that portal website would be the website to go to to print any of the explanation of benefits that you may need a copy of.
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][POSITIVE] OK. Thank you so much for that and
[CUSTOMER][POSITIVE] OK, thank you so much for that and.
[AGENT][NEUTRAL] And is it the same thing for each one you're needing additional information on the denial for the other three claims as well?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, yes. And could you please go ahead and provide the call reference number?
[AGENT][NEUTRAL] As I stated, it would be my name and today's date for each one.
[CUSTOMER][POSITIVE] Thank you so much. OK. Thank you so much for that, [PII]. Just a moment.
[AGENT][NEUTRAL] And the next policy number?
[CUSTOMER][NEUTRAL] Yeah, yeah, just a moment.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Thank you so much for that.
[CUSTOMER][NEUTRAL] OK. Could you please go ahead and, yeah, just a moment please.
[CUSTOMER][NEUTRAL] OK, the policy number is
[CUSTOMER][NEUTRAL] Y as in uh OK just a moment.
[CUSTOMER][NEUTRAL] 01986343.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Uh-huh, yeah, sure.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] is the name and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the date of service and total bill amount?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, date of service will be [PII] and the total amount is $50 even.
[AGENT][NEUTRAL] $50.50 dollars. Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm. Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said the amount, the total bill amount is $50 for a data service of $1125 2024?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, we do not have a claim on file for that data service and that bill amount.
[CUSTOMER][NEUTRAL] Let me check it again, please.
[CUSTOMER][NEUTRAL] OK. The total bill amount is $264.57. I'm sorry.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah that is.
[AGENT][NEUTRAL] OK, so the most recent received claim was denied as a duplicate of previously submitted expenses. Do you want the other claim number which is 3586043?
[CUSTOMER][NEUTRAL] Sorry
[CUSTOMER][NEUTRAL] Uh, OK. May I know we have submitted the fact to claim on [PII]. So I'm sorry, [PII] again. Um, could you please check that?
[AGENT][NEUTRAL] OK, so that claim number 35, the claim number is 3586043.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And it was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And the reason for the denial is that we are in need of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So you are the secondary, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you did not receive the EOB, is that right?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So we only need the EOB sent.
[CUSTOMER][NEUTRAL] Yeah the 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] OK just a moment.
[CUSTOMER][NEUTRAL] May I know the primary payer name?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I can only
[AGENT][NEUTRAL] I can only tell you what we show for the employer, and we show that to be Blue Cross and Blue Shield of Oklahoma.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] But that's all of the information I would have.
[CUSTOMER][NEUTRAL] OK, I know that.
[CUSTOMER][NEUTRAL] OK. So you're unable to provide the primary payer ID?
[CUSTOMER][NEUTRAL] Right, time to find limit to the mailing address as well for the primary payer.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you so much. Just a moment, please. OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Shall I take the time to filing number and the mailing address as we discussed for the previous claim?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much for that ma'am.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. Thank you so much for that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the next policy number?
[CUSTOMER][NEUTRAL] Yes, just a moment.
[CUSTOMER][NEUTRAL] How may I know from.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Could you please go ahead and, OK, just a moment please.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, the next policy number will be?
[CUSTOMER][NEUTRAL] 00
[CUSTOMER][NEUTRAL] 94
[CUSTOMER][NEUTRAL] 5121.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] ML [PII]. The date of birth is [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And the date of, uh, just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The date of uh birth is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the, what is the data service and total bill amount?
[CUSTOMER][NEUTRAL] Yeah, sure. The date of service is [PII] and the total amount is 5 I'm sorry, it's $54.41.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] You said 32 I'm sorry [PII] is the date of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so this this claim was received on 41.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Denied on 42.
[AGENT][NEUTRAL] The claim number you should have is 358.
[AGENT][NEUTRAL] 4110.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please repeat it?
[AGENT][NEUTRAL] 358-411-0.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the reason for the denial on this entire claim states this service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, so you mean to say that, that, OK, it's non-covered as for the pay.
[AGENT][NEGATIVE] It is not covered when.
[AGENT][NEUTRAL] Yes, for the patient's plan, it is not covered when performed in the doctor's office or clinic.
[CUSTOMER][NEUTRAL] Oh, OK. Thank you so much for that. OK, so it's non-covered as per the patient's benefit. OK, it's non-covered as per the um patient's plan, right?
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And do you need any other information on this one?
[CUSTOMER][POSITIVE] Thank you. Just um.
[CUSTOMER][NEUTRAL] Yes, yes, yes. Just a moment, please. Just a moment, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just a moment please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So shall I take the timely filing limit and the mailing address as we discussed from the previous claim? Will that be fine?
[AGENT][POSITIVE] Correct. Correct.
[CUSTOMER][NEUTRAL] OK. Just a moment. OK, just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Just a moment please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, shall I move with the next member ID?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][POSITIVE] Thank you so much for that.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Just a moment, it's loading.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure mom.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Just a moment please.
[CUSTOMER][POSITIVE] OK. Thank you so much for your patience. My system is loading just a moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Just a moment please it's loading unfortunately I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Sorry, just a moment.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][POSITIVE] Oh, OK. The next member ID is 02369826, and thank you so much for patiently staying connected. I appreciate your patience.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you so much for that.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK, there is [PII] and the date of birth is [PII].
[CUSTOMER][POSITIVE] Yeah, good.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Data services.
[CUSTOMER][NEUTRAL] [PII] total amount is $50 even.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][POSITIVE] Yeah, sure. No problem. Take your time.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so I'm not seeing a claim on file for her for 10-9-2024 for that bill amount.
[CUSTOMER][NEUTRAL] OK, we have submitted the collected claim on 3-27-2025 for the total bill amount. Let me check it.
[CUSTOMER][NEUTRAL] Just a moment please.
[AGENT][NEGATIVE] Yes, we haven't received that.
[AGENT][NEUTRAL] We do not have a claim for 109-2024.
[CUSTOMER][NEUTRAL] OK. OK. 318. OK. 318202, I'm sorry. The total amount is $318 318. I'm sorry for that.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] OK, no claim on file.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, so I did not receive the correct claim, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] OK. Shall I provide you the previous call reference number?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][NEUTRAL] No, no, the previous call reference number we do have because the rep told the denial reason for the claim on just a moment, it's a follow up call.
[AGENT][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Just a moment, please. OK. What about the initial claim we have submitted on the
[AGENT][NEUTRAL] I do not have a claim on file, yes ma'am, but for data service 10-9-2024, I do not have a claim for that bill amount. I do not have a claim for data service 10-9-2024.
[CUSTOMER][NEUTRAL] In the month of
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. We have received an EUV from the American Health. Shall I provide you that claim number, please?
[AGENT][NEUTRAL] That would not matter. I mean, you, if it, I can only look up an APL claim number.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] So there's no claim on file with us for that data service.
[CUSTOMER][NEUTRAL] Shall I provide you any other information then?
[AGENT][NEUTRAL] Uh, you would just need to submit the claim along with the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] OK, but we have received the EOB and the EOB says that outpatient benefits for this uh calendar year has been met.
[AGENT][NEUTRAL] What's your claim number for APL?
[CUSTOMER][NEUTRAL] 3585034
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So that is not for this member, for [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] That is an incorrect claim number. That claim number is not associated with her.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, I see the banks. Uh, the policy number for.
[CUSTOMER][POSITIVE] OK then. Thank you so much for your assistance and patience as well. Have a great day. Take care bye for now.
[AGENT][POSITIVE] Uh yes, ma'am. So thank you again for calling APL and I hope you have a nice day as well if that's all I can help you with. Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes bye bye.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Thanks bye bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.