AccountId: 011433970860
ContactId: f007eff8-4d9e-4098-8b84-023824cb888e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 685179 ms
Total Talk Time (AGENT): 185555 ms
Total Talk Time (CUSTOMER): 147848 ms
Interruptions: 2
Overall Sentiment: AGENT=0, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/f007eff8-4d9e-4098-8b84-023824cb888e_20250417T18:21_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] I need to check on a claim denial. Can you help me?
[AGENT][NEUTRAL] I can. Uh, could I get your name again?
[CUSTOMER][NEUTRAL] Sure, [PII]
[AGENT][NEUTRAL] [PII], OK. [PII], could I get a callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The policy number you're calling on?
[CUSTOMER][NEUTRAL] 971-111.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][POSITIVE] OK, thank you so much for verifying the policy. And you did say you were calling for.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] Claim status?
[CUSTOMER][NEGATIVE] Yes. Actually, it is a denial, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A claim denial.
[AGENT][NEUTRAL] Oh, claim denial. OK. And what is the date of service?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The total bill for it is
[CUSTOMER][NEUTRAL] 728.56.
[AGENT][NEUTRAL] OK, and what is the patient's name again?
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII], sure. [PII].
[AGENT][NEUTRAL] 724 2024.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The DOB is uh [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I have the claim number for it as well if you need.
[AGENT][NEUTRAL] OK, what is the claim number because that data service isn't coming up.
[CUSTOMER][NEUTRAL] OK. Uh, it's uh
[CUSTOMER][NEUTRAL] 3571568.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I show this is for data service [PII].
[CUSTOMER][NEUTRAL] Isn't, isn't that what I said? I, I don't, I don't know.
[AGENT][NEUTRAL] Oh, I I put in [PII], so maybe I did that wrong. I apologize. OK, so let's see.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let me see what the denial is.
[AGENT][NEUTRAL] 6
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] The office visit is not covered.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Let me see, let me check and see what's going on. It looks like the denial for the other charges are not correct.
[AGENT][NEGATIVE] OK, looks like the denial on the other charges are incorrect. I will have to send this claim back for reprocessing.
[CUSTOMER][NEUTRAL] OK. Regarding the CPD codes that you are mentioning, uh, is it like, uh, the codes other than 99214 or which CPT code are you referring to?
[AGENT][NEUTRAL] So the 99214 for the physician office is a non-covered charge. The policy does not cover the physician.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Office, the office visit, uh, the policy does cover, let me, let me make sure, let me take a look.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 32211
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK, so the other charges are covered under the policy, so I will need to send those back. Let me, let me pull the actual image and see.
[AGENT][NEUTRAL] Uh, hold one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold one moment for me please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, girl.
[AGENT][NEUTRAL] 13468151346715.
[AGENT][NEUTRAL] One
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] 01346815
[AGENT][NEUTRAL] The claim number is 359-0525.
[AGENT][NEUTRAL] Why is it asking for that?
[AGENT][NEGATIVE] I don't know what the hell is going on.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh my gosh, what is wrong?
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] OK, thank you for holding. I apologize for the wait. So I did um pull the claim and I will have it sent back for reprocessing. Um, the charges outside of the office visit uh were denied an error. The the wrong denial code was used on there, um, and I will send it back.
[CUSTOMER][NEUTRAL] Actually
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yes, actually, my point here is that like uh the CPD code G2211 is also like uh uh kind of an office visit code like ENM service code. So if you are stating that like uh evaluation and management services or office visits are not covered, then, um, that might not be covered as well and it might be denied correctly. But I just wanted the denial, so, uh, is that so that
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The office visits are not covered entirely.
[AGENT][NEUTRAL] So the
[AGENT][NEUTRAL] The office visit is not covered. The 992, um, I believe it's 99213.
[AGENT][NEGATIVE] Uh, that code is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And 32211 is an add-on code for that. So if that is not covered, uh,
[CUSTOMER][NEUTRAL] Uh, I don't think that would be.
[AGENT][NEUTRAL] Uh, I am not sure. Again, I will have to send it back for reprocessing. The claim needs to be reprocessed.
[CUSTOMER][NEUTRAL] Please, please, uh, all right. Please, I understand. Please do have it sent back. And also, I have like one more claim for the same patient and it, uh, it's the same case like the same CPT code G211 is being denied. So if you can send both of them all together or individually, however you.
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] I have uh [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, this is correct, both, uh.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEGATIVE] This one also needs to be sent back for reprocessing.
[CUSTOMER][NEUTRAL] All right. OK. So,
[CUSTOMER][NEUTRAL] All right. In that case, uh, yes, please do, uh, whatever is needful and uh please provide me a case or ticket number for it.
[AGENT][NEUTRAL] To reference the call, you can use my name, [PII]
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][POSITIVE] [PII]. All right. And that was it. Thank you.
[AGENT][POSITIVE] You're welcome. You have a wonderful day. Thank you for calling APL.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][NEUTRAL] Bye-bye.