AccountId: 011433970860
ContactId: 051337c8-e3f9-4e2d-aebe-658d9f5c88da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 262089 ms
Total Talk Time (AGENT): 114891 ms
Total Talk Time (CUSTOMER): 86912 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/051337c8-e3f9-4e2d-aebe-658d9f5c88da_20250220T20:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. My name is [PII], and I'm calling with SSM Health in Anthony Hospital on a recorded line.
[CUSTOMER][NEUTRAL] I'm trying to get uh a status of a claim. I'm not sure if it was received.
[AGENT][POSITIVE] OK, [PII], I'm happy to check on a claim for you today. Uh, do we have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, 024.
[CUSTOMER][NEUTRAL] 93439.
[AGENT][POSITIVE] Alright, thank you, let me pull this up here.
[AGENT][NEUTRAL] And if I can get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, this is for [PII]. Date of birth [PII].
[AGENT][POSITIVE] All right, thank you so much.
[AGENT][NEUTRAL] And then what's the date of service?
[CUSTOMER][NEUTRAL] Yes, date of service is [PII], with total charges of $3,107.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] OK, so it looks like we did receive a claim for that date of service. It was received [PII]. Uh, the claim was denied. It looks like the EOB wasn't legible from the primary, so we need that res.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, um, do you have an address or fax number where I can submit that?
[AGENT][POSITIVE] Absolutely. Which would you prefer? We have fax or we have mailing. I can give you both.
[CUSTOMER][NEUTRAL] on both, please.
[AGENT][NEUTRAL] OK, the fax number is gonna be [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the claim yep and the claims mailing address is going to be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII], [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII]. Perfect. OK, do I send that attention to someone in particular or?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh just attention claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, not for this, um, claim in particular, but, um, do you have timely filing for appeals and corrected claims?
[CUSTOMER][NEUTRAL] So I can take a note.
[AGENT][NEUTRAL] Um, so there's, yeah, no timely filing for like corrected claims appeals do have to be filed within 180 days of the decision.
[CUSTOMER][POSITIVE] OK perfect and can be submitted also to that address and fax or?
[AGENT][NEUTRAL] Um, appeals have to be, uh, submitted in writing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. Any um special form required, uh, like a provider form?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] No form is required for an appeal. It would just be, uh, needing to write the reason for the appeal. You can send it to that same address. Uh, you would just want mark attention to appeals at Aer you know, it's American Public Life.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. OK, well that was all for today, [PII], thank you very much. I will just need a call reference number.
[AGENT][NEUTRAL] Absolutely. So call reference will be my name with my last initial then today's date. My name is [PII] again, [PII] Last initial is [PII].
[CUSTOMER][POSITIVE] Perfect. Thank you very much. I hope you have a great afternoon.
[AGENT][NEUTRAL] You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.