AccountId: 011433970860
ContactId: f0d03f0f-f29f-4d1d-8f93-3fbea066e91e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 334500 ms
Total Talk Time (AGENT): 130184 ms
Total Talk Time (CUSTOMER): 58586 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/f0d03f0f-f29f-4d1d-8f93-3fbea066e91e_20250117T19:51_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. I'm calling for the provider Orange Care Physician Parts of Florida LLC. Please note this call will be recorded and monitored for quality and training purposes, and I'm calling to check on your claim status.
[AGENT][NEUTRAL] OK, you said you have a claim status, so you only have one, is that correct?
[CUSTOMER][NEUTRAL] Two claims.
[AGENT][NEUTRAL] OK, so I can help you with status on both claims. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] The callback number is going to be [PII]. So direct line, there is no extension.
[AGENT][NEUTRAL] Thank you. So I believe I spoke to you a little while ago, [PII], but you will use my name along with today's date is your call reference number.
[AGENT][NEUTRAL] Any information that I provide for you on either claim will be a verification of benefits and not a guarantee of payment. And lastly, if you need the explanation of benefits for either of these claims if we have them on file, you may go to our portal and print them, and our portal website is secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Mhm thank you.
[AGENT][NEUTRAL] And what is the first patient's policy number?
[CUSTOMER][NEUTRAL] The policy number is going to be
[CUSTOMER][NEUTRAL] 02444790
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, 8.
[AGENT][NEUTRAL] Thank you. Date of uh excuse me, the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] The patient's first name is [PII], the last name is [PII]. And the date of birth is [PII].
[CUSTOMER][NEUTRAL] 66.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And again the do the service and total bill amount, please.
[CUSTOMER][NEUTRAL] D of service was [PII].
[CUSTOMER][NEUTRAL] And the total bill amount is
[CUSTOMER][NEUTRAL] $615.02.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK [PII], so this one was received on [PII].
[AGENT][NEUTRAL] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 352-551-0.
[AGENT][NEUTRAL] And the reason for the denial on this claim?
[AGENT][NEUTRAL] One of them states policy provides no benefits for the treatment of conditions other than a sickness or injury as defined by the policy, that is on 99396.
[AGENT][NEUTRAL] There were 3, uh 12.
[AGENT][NEUTRAL] 5 other codes denied stating benefits are payable only if your major medical insurance provider provides benefits. If this claim is later paid by your major medical insurance, please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And there are 3 denial codes stating this policy does not provide a benefit for services in which no charges were incurred.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the claim was denied due to, could you please give me the denied reason once again for me? I want to document that.
[AGENT][NEUTRAL] Code 99396 was denied if policy provides no benefits.
[AGENT][NEUTRAL] For the treatment of conditions.
[AGENT][NEUTRAL] Other than a sickness or injury as defined by the policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, thank you. And what you need you to submit an appeal?
[AGENT][NEUTRAL] Then, mhm.
[AGENT][NEUTRAL] On these types of policy