AccountId: 011433970860
ContactId: c8926909-0d32-40ac-a57e-dba0f9d63ad8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 214330 ms
Total Talk Time (AGENT): 84102 ms
Total Talk Time (CUSTOMER): 80051 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/c8926909-0d32-40ac-a57e-dba0f9d63ad8_20250304T18:27_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling with the provider's office. I'm trying to check on a claim status.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with that. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] Uh, call back [PII] direct policy number 02262377ML8.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]'s [PII].
[AGENT][NEUTRAL] And I apologize. What was your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Are you calling to check the status of a claim for what date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Do you have a procedure code?
[CUSTOMER][NEUTRAL] Um, I guess the whole claim, so initially it was sent to the primary Aetna, and I said when I submitted it to you guys, um.
[CUSTOMER][NEGATIVE] I had um called the plan. I called you guys and you guys said that it was denied because it needed the primary payers EOB so I faxed that in but then I just received like a duplicate denial, so I wasn't sure what I was supposed to be doing next.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] You received a duplicate denial for one procedure code, not both procedure codes.
[AGENT][NEUTRAL] Offices are not covered, so they would be considered as a duplicate. However, the procedure code of 36415, that wasn't considered as a duplicate. It was considered as the benefits were paid by the primary, primary made for benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, so my question would be about line item one then why was it denied as a duplicate?
[AGENT][NEUTRAL] Because when the first time you process the claim.
[AGENT][NEUTRAL] We don't cover office visits. The policy doesn't cover office visits. So when you submitted it a second time when we requested the the EOB to be sent in for the procedure code of 36415.
[AGENT][NEUTRAL] We did, do you have both of those EOBs?
[CUSTOMER][NEGATIVE] Oh, OK. No, so I only called in. I called in only because I hadn't gotten a response back from the plan. So, um, when I called on [PII], the representative gave me the claim number and when they had received it and that it had denied, um, but I never actually received that EOB.
[AGENT][NEUTRAL] Got you, so I can send you the EOB.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Bear with me, I'm gonna request your fax number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Sir, what's your fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I have [PII].
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][POSITIVE] OK, I'm sending this over for you now.
[CUSTOMER][NEUTRAL] OK, thanks so much. um, am I able to get I guess just a reference number for the call?
[AGENT][NEUTRAL] We don't provide those, however, you can use my name and today's date as a reference is [PII] and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thanks so much.
[AGENT][POSITIVE] You're welcome thanks for calling APL. Have a great day. Goodbye.
[CUSTOMER][NEUTRAL] You too bye.