AccountId: 011433970860
ContactId: dde486c6-faa3-49fd-b2a3-2999af7b12b2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 461940 ms
Total Talk Time (AGENT): 215423 ms
Total Talk Time (CUSTOMER): 175181 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/dde486c6-faa3-49fd-b2a3-2999af7b12b2_20250115T14:50_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting APO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from provider's office to check on a client and I should to send everything today, [PII].
[AGENT][NEUTRAL] Uh yes, hi, um, I sure I can certainly help with the claim status. What's that policy number, please?
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] Sure, and the policy number is 014.
[CUSTOMER][NEUTRAL] 62911.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Sure, and the patient's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, I appreciate that. If there's a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Sure, and the contact number is [PII].
[AGENT][POSITIVE] That's great. What is the data service that we're looking for for [PII]?
[CUSTOMER][NEUTRAL] And for this claim, the rate of service is April 25, 2024.
[AGENT][NEUTRAL] April the 2.
[CUSTOMER][NEUTRAL] And the bill amount is 100, sir.
[AGENT][NEUTRAL] I'm sorry, you said April the the what?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's April 25.
[AGENT][NEUTRAL] 0, 25, OK, yes, and the, and the build out, please?
[CUSTOMER][NEUTRAL] It's $179 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, your claim number is 35466.
[AGENT][NEUTRAL] 02.
[AGENT][NEUTRAL] And it looks like uh we received your claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] We received your claim on the [PII]. We processed it on the [PII]. Now for CPT code 99213.
[AGENT][NEUTRAL] The policy does not cover office visits, so that was just not covered.
[AGENT][NEUTRAL] 4
[CUSTOMER][POSITIVE] Yeah, OK. And you can, yeah, go on with that, sir. Sorry for that.
[AGENT][NEUTRAL] Yeah, go ahead, please.
[AGENT][NEUTRAL] I was just gonna say CPT code Q uh oh go ahead. I'm sorry, sorry, go ahead.
[CUSTOMER][NEUTRAL] And you
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Yesterday it doesnt nice in non-covered as per members now or the providers plan.
[AGENT][NEUTRAL] It's the member's plan.
[CUSTOMER][NEUTRAL] Yeah, OK, and may I also know the member's plan type, please?
[AGENT][NEUTRAL] That, you mean the date that it started or the, the type of plan it is?
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] Yeah, the type of plan for member.
[AGENT][NEUTRAL] Yes, this is a secondary or gap insurance.
[CUSTOMER][NEUTRAL] It's.
[CUSTOMER][NEUTRAL] Yeah, OK. And could you please also confirm with me, [PII], if the procedure code will not be covered or the diagnosis could not be covered?
[AGENT][NEGATIVE] The procedure code will not be covered.
[CUSTOMER][NEUTRAL] Yeah, OK. The, and the member doesn't have a Medicare benefits?
[AGENT][NEUTRAL] Well, not, uh, not for the office visits, no. Um.
[AGENT][NEUTRAL] Now, now, he may through his major medical but not through us.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, OK. Thanks for those information, [PII]. And could you please also confirm with me what is the denying reason for 83036?
[AGENT][NEUTRAL] Uh, that the denial reason was, uh, was it just, just that it was not covered.
[CUSTOMER][NEUTRAL] Yeah, OK, both are for the same denial reason.
[AGENT][POSITIVE] That's right, yes.
[CUSTOMER][NEUTRAL] Yeah, OK. Yeah, OK. And could you please also confirm with me, is there any restriction for uh to bill the patients for the non-cover services?
[AGENT][NEUTRAL] Well, it's, uh, I can't really tell you that. I can just tell you that we don't cover it. Um, I really don't know whether they have any more insurance besides us, so, uh, I don't know whether they would, you would need to check with them, but I, the only thing that I can tell you is that, uh, by our our contractual obligation, um, does not cover this. And that's really, I'm sorry, that's really the only thing I could say.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Yeah, OK, thanks for this information, [PII]. And is it possible to provide me with the contact and mailing address and the timely filing in, please?
[AGENT][NEGATIVE] Yes, there's no timely filing and the mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That is in [PII].
[AGENT][NEUTRAL] And the zip code is [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, OK, thanks for this information, [PII]. And please, could you please also confirm with me if you send any, but if you send any procedure code and if you submit a contact claim with the claim to be processed.
[AGENT][NEUTRAL] You can send it back to be, I mean you can send it back as an appeal if you like.
[CUSTOMER][NEUTRAL] Yeah, OK, thanks for this information. The answer I have 2 more claims. Can I move the next claim? And for the next claim it will be for the same number but for different date of service.
[AGENT][NEUTRAL] OK, let me get to that screen. Excuse me just a moment, please. And what is the date of service for her?
[CUSTOMER][NEUTRAL] And it's for [PII].
[CUSTOMER][NEUTRAL] On my face.
[AGENT][NEUTRAL] OK, the claim number for this one is 354.
[AGENT][NEUTRAL] 661-3.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] We received your your claim on the [PII] and processed it on the [PII]. This is the same thing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Where the office visit is not covered under her policy with us.
[CUSTOMER][POSITIVE] Yeah, OK, thanks for those information, [PII].
[CUSTOMER][NEUTRAL] And can I monit the next member?
[AGENT][NEUTRAL] Yes, and what, excuse me just a moment please. What is that policy number, please?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And the policy number is 1462936.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Sure, and the patient's name is [PII], sorry, [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what date of service are we looking for for [PII]?
[CUSTOMER][NEUTRAL] And it's for [PII].
[AGENT][NEUTRAL] And the build out?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] One moment, please. It's $120 even.
[AGENT][NEUTRAL] Your claim number is 35.
[AGENT][NEUTRAL] 45
[AGENT][NEUTRAL] 495.
[AGENT][NEUTRAL] It looks like we received your claim.
[AGENT][NEUTRAL] On the [PII] and we process it on the [PII].
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] [PII] has the same, same sort of policy um where the uh
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, office visit is not covered.
[CUSTOMER][NEUTRAL] Yeah, OK, thanks for this information, [PII], and could you please also confirm, is it for a HMO or a PPO plan for a member? It's the same second.
[AGENT][NEUTRAL] This is a, this plan, yeah, this, what this plan is, is, is a gap insurance. It's a secondary insurance. So it's not HMO or PTO it's, yeah.
[CUSTOMER][NEUTRAL] It's a second.
[CUSTOMER][POSITIVE] Yeah, OK, thanks for this information. And including for this claim, even if you send the claim by changing a it will now be processed.
[AGENT][NEUTRAL] Well, it won't be paid because it's not covered under the policy. But if you, but as before, if you want to send it back as an appeal, uh you can try that, but it's just not covered under this policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, OK, thanks for this information, [PII]. Yeah, and can I also your call reference number please for our organization.
[AGENT][NEUTRAL] My name
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII], and we're gonna use that today's date as a reference. Is there anything else at all I can help with?
[CUSTOMER][POSITIVE] No, that's all about [PII]. Thanks for this information and thank you for your assistance and have a lovely day and have a great weekend too.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thanks for thanks for contacting AP have a good.
[CUSTOMER][NEUTRAL] Yeah