AccountId: 011433970860
ContactId: fd199caf-7280-48ea-b279-2c45c5a9b100
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 536109 ms
Total Talk Time (AGENT): 169941 ms
Total Talk Time (CUSTOMER): 190103 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/fd199caf-7280-48ea-b279-2c45c5a9b100_20250529T13:29_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, this is [PII], and I'm calling from Pro's office, and I'm looking for the claim status.
[AGENT][NEUTRAL] OK, well, I'll be more than happy to help you with the claim status, [PII]. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I have 2 claims.
[AGENT][NEUTRAL] OK, and may I have a good contact number in case we're disconnected and the first member's policy number?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes, uh, my callback number is [PII]. It's a direct line, and the policy number for the patient is
[CUSTOMER][NEUTRAL] 249-615-1
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, patient name is [PII], and the date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] It is [PII] with the total bill amount of $567 even.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Uh sure.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Certified Foot and ankle specialist.
[CUSTOMER][NEUTRAL] They must
[AGENT][NEUTRAL] I'm sorry. Can you repeat that, please?
[CUSTOMER][POSITIVE] Yes, it's a certified foot and ankle specialist.
[AGENT][NEUTRAL] Can you verify the tax ID?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you for that, and I'm showing that we received the claim.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 572 4.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And on [PII], we denied the claim.
[AGENT][NEUTRAL] Because office visits are not covered by this policy, um for 99203.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And for 73,630, um, let me see.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] It's showing the insurance primary insurance paid for benefits, so there were no benefits payable.
[CUSTOMER][NEUTRAL] So the office is not covered for the patient policy, right?
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] The time is there because the office office visits are not covered for this patient's policy, am I right?
[AGENT][NEGATIVE] Right, the office code, the 99203, yes, it was denied because office visits aren't covered and the other code on the policy was denied because primary insurance paid all the benefits.
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Can I have a primary?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Bing, is it.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Medicare
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] The primary insurance is Aetna.
[CUSTOMER][NEUTRAL] OK, so for the CP code [PII], the primary Aetna must process all the benefits, so there is no leftover for the secondary, right? That's why.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] It got in at a
[CUSTOMER][NEUTRAL] A and uh for the CP code [PII], we need to bill the bill the amount to the patient.
[CUSTOMER][NEUTRAL] Because it's not covered, right? That's the occupation policy.
[AGENT][NEUTRAL] Um, we
[AGENT][NEUTRAL] We don't
[AGENT][NEUTRAL] We don't determine patient responsibility.
[CUSTOMER][NEUTRAL] OK, and uh
[CUSTOMER][NEUTRAL] Can I have the a pill, like a pill or recon insurance information?
[AGENT][NEUTRAL] Sure, I'm sorry [PII]'s mailing address is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] uh
[CUSTOMER][NEUTRAL] And is there a fax number?
[AGENT][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And they'll both be um to the APL appeals department.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh can I have the time limit for somebody in the?
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] For an appeal is 180 days from the denial date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I have another uh data service. Tell me about that.
[AGENT][NEUTRAL] For the same member?
[CUSTOMER][NEUTRAL] Yes, same number.
[AGENT][NEUTRAL] OK, and the next day of service?
[CUSTOMER][NEUTRAL] Uh, [PII], but the bill amount of $347 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Wow
[AGENT][NEUTRAL] Alright, so for this claim, we received it on [PII], I'm sorry, on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim number is 359-573-3.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] Did you
[CUSTOMER][NEUTRAL] Can I have the patient policy name?
[AGENT][NEUTRAL] This is the Medlink supplemental gap insurance.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Meddling supplemental.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Supplemental gap insurance?
[CUSTOMER][NEUTRAL] Gap, OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Uh thank you for the information. And uh can I have the dinner date again? It's [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. And uh can I have your name and the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. And again, that's [PII], [PII] to my last name is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much. Uh.
[AGENT][NEUTRAL] You're welcome. Was there anything else I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] No, that's all. Thank you.
[AGENT][POSITIVE] All right, thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] You too. Goodbye.