AccountId: 011433970860
ContactId: f94e78d1-8562-4981-ac56-6b592aab9005
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 526650 ms
Total Talk Time (AGENT): 136584 ms
Total Talk Time (CUSTOMER): 191326 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/f94e78d1-8562-4981-ac56-6b592aab9005_20250408T18:43_UTC.wav
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[CUSTOMER][NEUTRAL] really
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, my name is [PII] calling from provider office checking on client status.
[AGENT][POSITIVE] All right, [PII], I'm happy to check on a claim for you today. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Um, just hold on a moment pulling up on that one.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you for patiently waiting and that policy number I do have on file is uh
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh did
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] 2, sorry, 02286385. M as in Mary, L as in Lima, number 7.
[AGENT][POSITIVE] Thank you for that. And do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][NEUTRAL] May I please have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] And this is for member name of [PII]. Date of birth [PII].
[AGENT][NEUTRAL] And what's the date of service?
[CUSTOMER][NEUTRAL] And this is for a data service of um.
[CUSTOMER][NEUTRAL] Um, [PII] for $119 even.
[CUSTOMER][NEUTRAL] Can I get your name?
[AGENT][NEUTRAL] My name is [PII]. That is spelled [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We received a claim for the state of service on [PII].
[AGENT][NEUTRAL] The claim was denied [PII]. Office visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I'm sorry, D down.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] The need for office visit not covered under?
[AGENT][NEUTRAL] Member plan.
[CUSTOMER][NEUTRAL] Uh, can I get patient plan name?
[AGENT][NEUTRAL] We're the secondary insurance. This is a Medlink plan.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Medin like uh HMO or PPO or EPO type thing?
[AGENT][NEUTRAL] It's a secondary plan. It's a gap insurance.
[CUSTOMER][NEUTRAL] I is is there is any type like a PPO EPO or?
[AGENT][NEUTRAL] No, it follows the primary.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] So if we need to build the patient.
[AGENT][NEUTRAL] That's up to the facility or provider.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Because you said non-covered charges under that member plan, if you can bill the patient to the, the remaining charges.
[CUSTOMER][NEUTRAL] Because primary is already processed and paid for that service.
[AGENT][NEUTRAL] OK, so it's up to the provider to bill the patient for the residual balance.
[CUSTOMER][NEUTRAL] OK, can I get the claim number?
[AGENT][NEUTRAL] 353-248-3
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] It's 353-248-3.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, if I, if I can submit an appeal, is it possible or not? Like, uh,
[AGENT][NEUTRAL] No, it's too long. Appeals must be filed within 180 days of the decision. This claim was processed on [PII].
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So we can't able to file the appeal, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] But uh if it is we are within time if I can, we can able to appeal for that one.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] I'm sorry, what was your question again?
[CUSTOMER][NEUTRAL] If you, if you are within that uh timely filing, we can able to appeal, but we are out of the time frame so we can't able to appeal, right?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But it's uh under um you said 180 days from the date, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and also can I move for the next number, next patient?
[AGENT][NEUTRAL] I need to notate this patient then we can check the next one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, what's the next member's ID?
[CUSTOMER][NEUTRAL] Mm yes one moment to pull up on pulling up on that one.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] And uh thank you for patiently waiting. The next ID number I do have is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] That doesn't come up as a valid member number. Do you have their name or the claim number?
[CUSTOMER][NEUTRAL] Mm sure I do have uh one moment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, I do have claim number 3,514,830.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] And this is for member name um [PII] date bit of uh [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So this claim was received [PII].
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Claim is processed on [PII].
[AGENT][NEUTRAL] There was a benefit payment sent in the amount of $83.37.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This was in the amount of a single check.
[CUSTOMER][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] Is it paid, right? $83.37.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, did you receive any denial of this claim because we received one call has been denied, or did you have?
[AGENT][NEUTRAL] Correct. Procedure code 99213 was denied. Office visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] The CPT is uh 99, uh.
[AGENT][NEUTRAL] 213
[CUSTOMER][NEUTRAL] 213, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And that same uh dinner office which is non-covered under a member plan, uh, the same meddling plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, for this one also, we can't able to appeal, right? We are outside of the timely filing for this one also.
[AGENT][POSITIVE] Correct. Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get a reference number for this call?
[AGENT][NEUTRAL] Call references my name with my last initials and today's date. My name again is [PII], that's [PII] and then my last initial is [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK, thank you. Thank you, [PII]. Thank you for that information, sir, and uh you have a great day.
[AGENT][NEUTRAL] You too. Bye-bye.
[CUSTOMER][POSITIVE] Bye-bye. Take care.