AccountId: 011433970860
ContactId: 0653c7aa-c44e-47bb-a6b4-1c4a2e4efdbd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 539039 ms
Total Talk Time (AGENT): 137868 ms
Total Talk Time (CUSTOMER): 171372 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/0653c7aa-c44e-47bb-a6b4-1c4a2e4efdbd_20250612T17:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh, hi, [PII]. Very good morning. My name is [PII] calling from provider's office to check the claim status. Can you please help me with that?
[AGENT][NEUTRAL] I can help you with claim status. [PII], can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, it is [PII] direct line.
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] It is 02545505 M as in Mike L as in Lima number 8.
[AGENT][NEUTRAL] Alright, give me just one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth for me please?
[CUSTOMER][NEUTRAL] Yeah, it is [PII]. Date of birth is on [PII].
[AGENT][POSITIVE] Thank you so much for verifying that with me.
[AGENT][NEUTRAL] And do you have the claim number or the date of service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I have the date of service. It is on [PII]. Total charge amount is $542.
[AGENT][NEUTRAL] Give me just one moment.
[CUSTOMER][POSITIVE] Mhm thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, it looks like we received this claim on [PII]. It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 360.
[AGENT][NEUTRAL] 5384.
[AGENT][NEUTRAL] And it looks like this claim was denied because office visits aren't covered under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can I have the type of policy, the plan the patient had?
[AGENT][NEUTRAL] The type, yeah, give me just one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] This is Secondary gap insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, what kind of services does it cover?
[AGENT][POSITIVE] It covers inpatient and outpatient. It helps with co-pay, co-insurance, and co-deductible.
[CUSTOMER][NEUTRAL] OK. And one moment please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you still there?
[CUSTOMER][NEUTRAL] Uh yes, I'm there. Uh, is there any primary insurance for the patient?
[AGENT][NEUTRAL] Hm, let me look.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, it's Cigna.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh, is there any resolution for this claim, uh, to get paid? I mean, like any kind of sub, uh, uh, submitting an appeal?
[AGENT][NEUTRAL] Uh, you can submit an appeal.
[AGENT][NEUTRAL] Uh, within 10, I believe it's 180 days.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, 180 days from the date of denial.
[AGENT][NEUTRAL] Um, no, it'll be within 30 days of denial, and you have up to 180 days, uh, for us to approve or deny the appeal.
[CUSTOMER][NEUTRAL] So only 30 days from date of denial, right?
[AGENT][NEGATIVE] Uh, correct, and it looks like that was denied.
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] artificial
[CUSTOMER][NEUTRAL] OK. Uh, can I have the mail, uh, mailing address?
[AGENT][NEUTRAL] Sure you'll put attention appeals department.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Uh, can I have your name, please, once again?
[AGENT][NEUTRAL] Uh my name is [PII].
[AGENT][NEUTRAL] Last initial [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII], can you, uh, fax the EOB for this one?
[AGENT][NEUTRAL] Alright, give me just one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, don't have to worry about that.
[CUSTOMER][NEUTRAL] [PII] you'll be back.
[CUSTOMER][NEUTRAL] In the 7.
[CUSTOMER][NEUTRAL] Well.
[AGENT][NEUTRAL] OK, give me just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Name of the plan you are the mother customer list. That's another gap insuranced person.
[AGENT][NEUTRAL] And what is a good fax number to send this to?
[CUSTOMER][NEUTRAL] Yeah, it is [PII]. Attention with uh would be [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And just to confirm I have [PII].
[CUSTOMER][NEUTRAL] And uh previously previously payment.
[AGENT][NEUTRAL] 7773536 correct?
[CUSTOMER][NEUTRAL] Yeah, that's correct. And I have one more question that is, uh, was that the plan is, uh, according to the patient plan or according to the provider plan?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, this is the patient.
[CUSTOMER][NEUTRAL] OK. So the plan name is Secondary Gap Insurance?
[CUSTOMER][NEUTRAL] Is it?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh when I'm gonna receive that uh you will be?
[AGENT][NEUTRAL] Uh, it should be within the hour.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, that's it for today. Can I have the call reference?
[AGENT][NEUTRAL] So we don't have call reference numbers you can use my name and last initial in today's date.
[AGENT][NEUTRAL] So [PII] in today's date. Mhm.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][POSITIVE] All right. Thank you so much. Have a good day.
[AGENT][POSITIVE] OK thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Mhm. Bye-bye.
[AGENT][NEUTRAL] Bye.