AccountId: 011433970860
ContactId: e9d4a4e4-7bf4-4b5a-9433-74684f6e7010
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 812210 ms
Total Talk Time (AGENT): 202577 ms
Total Talk Time (CUSTOMER): 334893 ms
Interruptions: 8
Overall Sentiment: AGENT=1.1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/e9d4a4e4-7bf4-4b5a-9433-74684f6e7010_20250131T17:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, today. This is [PII] calling for the provider Tampa General Medical Group INC. Please be informed that this call is being recorded and monitored for quality and training purposes. I'm calling to check on a claim status.
[AGENT][NEUTRAL] OK, I can help you, and you said your name was [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, Miss [PII], what is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you. And then what was the name of the facility you're from again, please?
[CUSTOMER][NEUTRAL] Sure. It's Tampa, Tampa General Medical Group.
[AGENT][POSITIVE] OK, thank you so much. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Alright just a moment.
[CUSTOMER][NEUTRAL] And the patient's first name is [PII] and the last name is [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what's [PII]'s policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Sure. It's 224-455-6.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let me pull that in for us real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what is the date of service?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The service is [PII]. Total charges is $679 even.
[AGENT][NEUTRAL] $679 even on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up that claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much for holding for me [PII]. I do have the claim, the, the claim number is 353-529-3.
[CUSTOMER][NEUTRAL] 353-5293. Sorry for interrupting. I can't hear your voice properly. So can you please speak a little bit slower.
[AGENT][NEUTRAL] The claim was denied for.
[AGENT][NEUTRAL] Yes, the decline was denied for multiple reasons. One is office visit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, the claim number is 353-529-3.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was denied for multiple reasons, the first being office visits are not covered by the member's policy.
[CUSTOMER][NEUTRAL] There.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The second, the policy provides no benefits for the treatment of conditions unless there's sickness or injury.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The third is.
[CUSTOMER][NEUTRAL] So may I know the claim which received date? OK, OK, sorry, [PII].
[AGENT][NEUTRAL] Yes, let me finish. Let me finish. The 3rd is the policy does not provide a benefit for services in which no charges are incurred.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then let me look and see the dates for you.
[CUSTOMER][POSITIVE] That's good.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The first day is reported on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Just wait a moment.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, thank you for staying. Uh, OK. May I know the claim receive date? It's [PII]. Am I right?
[AGENT][NEUTRAL] Yes, and I see you called earlier for the same claim. Um, the claim was reported on [PII], and the claim was processed on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the design date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Uh, before I called, I didn't get the CPT code which is not covered. That's why I called you back.
[AGENT][NEUTRAL] The CPT code would be the one where office visits are not covered under the insured's policy.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK just a moment.
[AGENT][NEUTRAL] Do you have the claim, the EOB that has the CPT codes on it?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm just verifying. Just wait a moment.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I don't have the EOB.
[AGENT][NEUTRAL] OK, I can fax you the EOB. Can you give me your fax number please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, just a moment.
[CUSTOMER][NEUTRAL] Yeah, the fax number is [PII]. Pay attention to the patient's account number.
[CUSTOMER][NEUTRAL] It's going to be 73891 V as in Victor, 30,220.
[AGENT][NEUTRAL] Which is
[AGENT][NEUTRAL] OK, I'm gonna put you on hold while I fax that over to you. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK [PII], I have that X on its way to you.
[CUSTOMER][NEUTRAL] Yeah. Thank you. Uh, OK, please, I want to know whether the CPT or the diagnosis code is not good. I have two CPT codes, which is 993482599203, which is the code that has been denied or not covered for service.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, what was the first CPT code?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah, I have uh 993842599203.
[AGENT][NEUTRAL] Both of those were denied because office visits are not covered under the policy. That'll be on the EOB that I just sent to you also.
[CUSTOMER][NEUTRAL] I have this 2.
[CUSTOMER][POSITIVE] OK. Thank you so much. OK.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK. May I know this not covered under the payer guidance or patient plan or provider contract?
[AGENT][NEUTRAL] It's not covered under the patient's policy with APL.
[CUSTOMER][POSITIVE] Uh, patience time. Thank you so much.
[CUSTOMER][NEUTRAL] OK. May I know the mode of submission, whether we can submit a corrected claim or appeal?
[AGENT][NEUTRAL] Uh, you can send a claim correction. There's no time limit, but you'll need a letter Y. It needs to be corrected.
[CUSTOMER][NEUTRAL] Thank you. May I know the correct claim mailing address?
[AGENT][NEUTRAL] Yes, it's [PII] that's in [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Thank you so much. And you said there is no time filing limit, right? Thank you. Do you require a copy of denied EUB when we, we submit the corrected claim or when we decide to do an update?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Could you please mail out uh and you said you have been, you'll fax it, right?
[AGENT][NEUTRAL] Yes, I faxed it.
[CUSTOMER][NEUTRAL] The claim number is 353-5293. Am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, just processify the received date. It's [PII] and the denied date is [PII]. Am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. They see both the CPT codes have been uh not covered under the patient's plan, and we have to submit as and corrected claim to the mailing address.
[CUSTOMER][NEUTRAL] And the claim number I have verified with you. May I know the call reference number?
[AGENT][NEUTRAL] Yes, you can use my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] OK. [PII], right?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Your last initial, yes, am I right?
[AGENT][NEUTRAL] It's A
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thanks, [PII]. Thank you for your assistance. Have a great day.
[AGENT][POSITIVE] You too and you have a blessed weekend thanks for calling APL.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.
[AGENT][NEUTRAL] Mm. Bye-bye.