AccountId: 011433970860
ContactId: e1db6a7c-11e1-43c4-9dd9-5731813d5166
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 394989 ms
Total Talk Time (AGENT): 212989 ms
Total Talk Time (CUSTOMER): 111735 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/e1db6a7c-11e1-43c4-9dd9-5731813d5166_20250131T16:29_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, uh, I'm calling from the provider's office, uh, regarding a claim.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, how can I help you? Go ahead and give me your name and the member's policy number.
[CUSTOMER][NEUTRAL] Sure. My name is [PII]. And your name, please?
[AGENT][NEUTRAL] My name is [PII], that's [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah, hi [PII]. uh, the member policy number is 025.
[CUSTOMER][NEUTRAL] 18903
[AGENT][POSITIVE] Alright, [PII], thank you so much for that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Oh, bless you. That's OK, bless you.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alrighty, [PII], thank you for all that information. Um, what is your patient's name and date of birth today, please, ma'am?
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][POSITIVE] I'm so sorry.
[AGENT][NEUTRAL] That's OK, [PII], no problem. OK, [PII], looks like [PII] is the insured on this medical supplemental plan. How can I help you today on Gerardo?
[CUSTOMER][NEUTRAL] I'm calling to check on a claim status.
[AGENT][NEUTRAL] OK, what's the date of service, please, ma'am?
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] [PII] bill amount $282.06.
[AGENT][NEUTRAL] Alrighty, give me just a moment. Let me do some research. Let's see, 1024.
[AGENT][NEUTRAL] And what was your total amount billed?
[CUSTOMER][NEUTRAL] $282.06.
[AGENT][NEUTRAL] Yes ma'am, I do see that claim has been processed. Looks like your office will be getting a check for 9246. The charge for the, excuse me, the charge for the office visit is not covered here at all, but you should be getting a check for 9246.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Let me see when that.
[CUSTOMER][NEUTRAL] OK, when was this claim processed?
[AGENT][NEUTRAL] Let's see when this check went out.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Well, this check, uh, this check is dated [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am. Looks like it went to [PII] foot and ankle.
[AGENT][NEUTRAL] [PII]. Is that the correct address?
[CUSTOMER][NEUTRAL] Uh, [PII] or [PII]?
[AGENT][NEUTRAL] I mean [PII]. Yes, ma'am, that's where it went, and it's for $92.46. You want me to give you that check number so you can maybe do a little research just to see if you can locate it?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Yes ma'am. Your check number is 202.
[AGENT][NEUTRAL] 1125.
[CUSTOMER][NEUTRAL] And was that a bulk check or single check?
[AGENT][NEUTRAL] It's gonna be a single check for $92.46. And let me also give you that claim number, Destiny, just so you'll have that for reference.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] It's going to be 354.
[AGENT][NEUTRAL] 7194.
[CUSTOMER][NEUTRAL] OK. And when was this claim processed?
[AGENT][NEUTRAL] Uh, it was processed on [PII].
[CUSTOMER][NEUTRAL] OK, and on the same day the payment was also issued, right?
[AGENT][NEUTRAL] That's what that was.
[AGENT][NEUTRAL] Uh, that's what day the claim was processed was the check date. You want to know what day we received the claim?
[CUSTOMER][NEUTRAL] Uh, no, that's OK. And uh why 99213 is not covered?
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Yeah, they don't have office visit benefits here at all.
[AGENT][NEUTRAL] It's not a covered policy under this medical supplemental plan.
[CUSTOMER][NEUTRAL] OK, so there is no office visit covered under the member supplemental plan, correct?
[AGENT][POSITIVE] That is correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] If we send an appeal then also it's not covered?
[AGENT][NEGATIVE] You can, you're more than welcome to send the appeal, but it's still not gonna be covered.
[CUSTOMER][NEUTRAL] OK, how can we send an appeal then?
[AGENT][NEUTRAL] Uh, you can send an appeal to our address at [PII].
[AGENT][NEUTRAL] Appeals department.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] It's in [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And our zip code is [PII].
[CUSTOMER][NEUTRAL] OK, is there any fax number?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, and uh.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Was that
[CUSTOMER][NEUTRAL] What is the timely filing limit to send the afield?
[AGENT][NEUTRAL] We do not have a timely filing limit, so you can send that at any time.
[AGENT][NEUTRAL] Is that all that I can help answer for you on this claim, [PII]?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, that's all if I, uh, reference number please.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We don't give reference numbers, uh, [PII], but you can use my name in today's date, OK?
[CUSTOMER][NEUTRAL] And your last name initial?
[AGENT][NEUTRAL] Oh,
[CUSTOMER][POSITIVE] OK, thank you. Have a great day and have a wonderful weekend. Bye bye.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] You wish well, [PII]. Thank you for calling APL. Bye-bye.