AccountId: 011433970860
ContactId: bf684daf-e440-4df4-bcf0-42f0fe6c42c9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 588299 ms
Total Talk Time (AGENT): 206790 ms
Total Talk Time (CUSTOMER): 230222 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/bf684daf-e440-4df4-bcf0-42f0fe6c42c9_20250106T14:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, can you look up uh.
[CUSTOMER][NEUTRAL] I guess my
[CUSTOMER][NEUTRAL] Was it my, my, my policy number?
[AGENT][NEUTRAL] Um, yes, sir. I can assist you with your policy and benefits. First, could I get your name and a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Thank you, [PII]. One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And could I get your policy number, please?
[CUSTOMER][NEUTRAL] It's 0165.
[CUSTOMER][NEUTRAL] 91
[CUSTOMER][NEUTRAL] 47
[AGENT][NEUTRAL] OK, and please verify your first and last name and your date of birth, please.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Now, please verify your mailing address and email address to make sure we have the correct ones on file.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Please verify your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes, sir. And how can I help you?
[CUSTOMER][NEUTRAL] OK, is there any, is there any.
[CUSTOMER][NEUTRAL] Any bills that have been that's been submitted that's been declined.
[CUSTOMER][NEUTRAL] From the dermatology group.
[CUSTOMER][NEUTRAL] Of, uh, [PII].
[AGENT][NEUTRAL] Um, yes, sir. I'm showing a claim for date of service [PII]. I'm showing that it was denied because, let's see.
[CUSTOMER][NEUTRAL] Wait, 99 [PII]?
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] is the date of service.
[CUSTOMER][NEUTRAL] Oh [PII]?
[CUSTOMER][NEUTRAL] And what was the reason for the
[CUSTOMER][NEUTRAL] What was the reason for the decline?
[AGENT][NEUTRAL] Um, it's showing that this claim denied because the claim that the provider sent us, um, the procedure codes, they need to resend the claim with correct procedure codes because the procedure codes that they sent, we weren't able to find those in our system.
[AGENT][POSITIVE] So they can resubmit the claim with the correct procedure codes and we can get the claim processed and paid correctly.
[CUSTOMER][NEUTRAL] And what is the procedure called?
[AGENT][NEUTRAL] The procedure code.
[CUSTOMER][NEUTRAL] What number what number?
[CUSTOMER][NEUTRAL] OK, they put they, I, I'm on my, on my, is that the only is that the only date that's that's been declined?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, the procedure code they used was 96999. That's wrong?
[AGENT][POSITIVE] That's correct. Yes, it is.
[CUSTOMER][NEUTRAL] OK, what's the correct procedure code?
[AGENT][NEUTRAL] Um, we wouldn't know.
[CUSTOMER][NEGATIVE] The reason why I'm asking the reason why, the reason why I'm asking is I've gone through this before with my dermatology office, and what's happening is they're using, I guess they use a payment service, OK, and I, I don't know why they use it, uh, the wrong procedure code and now the divide they're they're they're, they're refusing, uh, my, my, um, medical treatment because they're saying that payment is not being submitted.
[CUSTOMER][NEUTRAL] And I spoke to the office manager. I told him, look, you're, we went through this before about a year ago.
[CUSTOMER][NEGATIVE] And uh what's happening is the same thing they use the wrong procedure code. I said how come how come your payment service can't use the correct submit the uh correct procedure code so it can get paid.
[CUSTOMER][NEUTRAL] So what is the correct procedure codes there is there a way you could tell me?
[AGENT][NEUTRAL] No, sir, because we're not in the office. It's up to them to um send us the bill to let us know what happened during your office visit.
[AGENT][NEUTRAL] So you will need to contact them. I just looked up the code and it says unlisted special dermatological Service or procedure. It's saying that it's unlisted.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So, maybe you could speak with your doctor.
[CUSTOMER][NEUTRAL] OK, so I know I, I know, I know I've, I've gone, I've gone to other treatments.
[CUSTOMER][NEUTRAL] Besides that, uh, I, I go like twice a month.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So those all the payments have been paid?
[AGENT][NEUTRAL] Let's see. um
[CUSTOMER][NEUTRAL] How come, how come I have, I have, I have a, I have a, um, this is from I have a.
[CUSTOMER][NEUTRAL] A a payment um.
[CUSTOMER][NEUTRAL] I got EOB here in front of me from it's from [PII].
[CUSTOMER][NEUTRAL] And the procedure code was 96999.
[CUSTOMER][NEUTRAL] And the the the amount was paid.
[CUSTOMER][NEUTRAL] It was submitted and it was paid under that code.
[AGENT][NEUTRAL] Um, no, I'm showing where those codes are um denied cause I'm showing you have another claim on file for [PII] and I'm showing that you had one code, um 96921. That one was paid cause that's an actual code. And then I see the code 96999 and that one was the 9.
[AGENT][NEUTRAL] It's for date of service [PII].
[AGENT][NEUTRAL] That's the other claim I'm showing on file for you.
[CUSTOMER][NEUTRAL] Hold on a second, let me see here.
[CUSTOMER][NEUTRAL] 112.
[AGENT][NEUTRAL] Mhm. 1224.
[CUSTOMER][NEUTRAL] Date of date of service oh hold on a second date of service.
[CUSTOMER][NEUTRAL] That's back in [PII]?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, sir. That's the other claim I'm showing on file. That one paid because um it's showing the 96999 well procedure code which denied, but then there's another procedure code that paid 96921. That one paid because it's an actual code, so.
[CUSTOMER][NEUTRAL] OK, that's what I was asking you, so the correct code they're supposed to be using is 96921.
[AGENT][NEUTRAL] I assume so. Yes, sir. You, you need.
[CUSTOMER][NEUTRAL] It's, it's uh I mean I'm going in for, I'm, I'm going in for laser treatment. It's the same, it's the same medical treatment every time as I'm not doing any different, so the correct.
[AGENT][NEUTRAL] OK. Well, you can make note of this code and call them and um let them know that they would need to resubmit the claim with that code because that code is actually paying.
[CUSTOMER][NEUTRAL] 96921
[AGENT][NEUTRAL] 21. Yes, sir.
[CUSTOMER][NEUTRAL] OK, so, um.
[CUSTOMER][NEUTRAL] OK, so this you're showing, so you're showing [PII], [PII]. Those are the only two payments that's been declined, um, yeah, to, to office, uh.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] That
[CUSTOMER][NEUTRAL] For that year for the [PII] because [PII] I haven't gone yet.
[CUSTOMER][NEUTRAL] So [PII] there's only two procedure uh claims that were submitted under the wrong code, is that what you're saying?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, OK, let me see if I can make contact with it here.
[AGENT][NEUTRAL] OK. And you also, and you also have a new policy number. Would you like your new policy number to give them also so when they file the claim, they can file it under the correct policy.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] I, I never received a new policy. Uh, I never received, uh, received a new card.
[AGENT][NEUTRAL] Well, I can um send you a new card with your new policy number on it. I'll have one mailed to you.
[CUSTOMER][NEUTRAL] Yeah, this, uh, for when did they when did they send out the new card?
[CUSTOMER][NEUTRAL] For this year?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see when was it originally sent?
[AGENT][NEUTRAL] Um, it should have been sent last year because this is your new policy number as of [PII].
[CUSTOMER][NEUTRAL] Hold on, let me see if I have it here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] Yeah, I don't, I don't even have it. I don't even have it. Can you send me, send me the new card to meal can you give me the.
[AGENT][NEUTRAL] Yes, sir. I can see.
[CUSTOMER][NEUTRAL] OK, can you give me a new policy number so I can give it to them also?
[AGENT][NEUTRAL] Yes, your new policy number is.
[AGENT][NEUTRAL] 025.
[AGENT][NEUTRAL] 05666.
[CUSTOMER][NEUTRAL] So 02505666.
[AGENT][NEUTRAL] Yes, sir. That's your new policy number as of [PII].
[CUSTOMER][NEUTRAL] That's, and that's a new part.
[CUSTOMER][NEUTRAL] As of Ja
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, OK, thank you, miss.
[AGENT][NEUTRAL] Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] No, that's it
[AGENT][POSITIVE] OK. Well, I thank you again, [PII] for calling ATL. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] OK thanks OK thank you.
[AGENT][POSITIVE] Thank you.