AccountId: 011433970860
ContactId: 057d61d4-25a9-4357-a646-fd0ece530379
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313609 ms
Total Talk Time (AGENT): 116319 ms
Total Talk Time (CUSTOMER): 86470 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/057d61d4-25a9-4357-a646-fd0ece530379_20250221T13:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hey, this is [PII], and I'm calling from provider office and I'm looking for a claims appeal status.
[AGENT][NEUTRAL] OK, [PII], you're needing an appeal status on a claim, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] OK. Can you repeat your phone number one more time? [PII].
[CUSTOMER][NEUTRAL] Uh, sure, one second. It's [PII].
[AGENT][NEUTRAL] OK, [PII], start over again because that's, yes, sir, can you start over again because that's different than what you gave me initially. So what is the full phone number again?
[CUSTOMER][NEUTRAL] Extension [PII] [PII].
[CUSTOMER][NEUTRAL] All right, now it is [PII].
[AGENT][NEUTRAL] Thank you. And what is the claim, excuse me, the policy number for the member you're calling about? I can help you with this.
[CUSTOMER][NEUTRAL] Um it's
[CUSTOMER][NEUTRAL] 01988243 M as in Mike, L as in Lima, then number 8.
[AGENT][POSITIVE] OK, [PII], thank you one moment.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the data service that you're calling about and total bill amount?
[CUSTOMER][NEUTRAL] Uh it's uh December 12, 2023 with the amount of $213,619.90.
[AGENT][NEUTRAL] OK, so again that was data service 1212 of 2023 for 213,619.90. Is that correct?
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, [PII], I do not I show where we received the original claim and it was processed, but I do not see an appeal on file for this member for this data service.
[CUSTOMER][NEUTRAL] Uh, OK, can you please, uh,
[AGENT][NEUTRAL] I see that we received a duplicate claim, but not an appeal.
[CUSTOMER][NEUTRAL] OK. So can you please verify with the appeal address because we sent this appeal on [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. [PII].
[AGENT][NEUTRAL] Yes, did you put it to attention appeals department, otherwise that could possibly be the duplicate claim. An appeal must be submitted in writing within 180 days from the date of the decision, and this claim was reviewed.
[AGENT][NEUTRAL] Um, the appeal time frame has expired. This claim was processed [PII].
[CUSTOMER][POSITIVE] All right. Thank you so much for this information. Can I have the card reference number now?
[AGENT][NEUTRAL] Yes, you would use my name along with today's date and then also if you need a copy of this explanation of benefits, you may print that by going to our portal at [PII].