AccountId: 011433970860
ContactId: 09c66a1e-de6b-430a-859c-7c440e901212
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 535000 ms
Total Talk Time (AGENT): 135977 ms
Total Talk Time (CUSTOMER): 139516 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/09c66a1e-de6b-430a-859c-7c440e901212_20250313T19:47_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office to check on the claim status.
[AGENT][NEUTRAL] OK, I can help you see with the claim status. Can I please get your number and the facility you're calling from?
[CUSTOMER][NEUTRAL] Can I please
[CUSTOMER][NEUTRAL] Yes, I
[CUSTOMER][NEUTRAL] [PII] is a direct line and I'm calling from Advanced Pain Management.
[AGENT][NEUTRAL] OK, and then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The member's policy number is 0233.
[CUSTOMER][NEUTRAL] 7756 M as in Mary, I as in ice.
[CUSTOMER][NEUTRAL] Number 8 member's name is [PII]. [PII] is the member's date of birth.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, let me pull up that policy real quick.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now.
[AGENT][NEUTRAL] OK, and then what is the data service and the charge amount for [PII]?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] [PII] with $1200 even bill amount.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] The primary insurance process to deductible for $632.36.
[AGENT][NEUTRAL] OK. All right, I'm gonna put you on a brief hold while I look up this claim and I will be right back.
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][POSITIVE] Thank, thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. This um claim number is 356-583-1.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The claim was denied because durable medical equipment is not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK, just a moment. Uh, first of all, the claim number is 356-583-1, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and what did you mention?
[AGENT][NEGATIVE] It was denied because durable medical equipment is not covered under the patient's policy.
[CUSTOMER][NEGATIVE] Uh, your call is cutting again. You're stating that it is denied as durable medical.
[CUSTOMER][NEUTRAL] What's the next one?
[AGENT][NEUTRAL] Durable, durable medical equipment is not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] So the CPT code, which is the L0648 is not covered as per the member spend as it's due to medical equipment does not cover the patient policy. Can I get the claim receipt date and the last process date?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Let me look that up.
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] And process the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And this claim was processed as secondary right because the primary insurance you see it has been already processed as deductible and that is why we have submitted the claim to Secondary American Public Life Insurance.
[AGENT][NEUTRAL] Right, the claim was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, can I get the mailing address is [PII]?
[AGENT][NEUTRAL] Yes you can it's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] And the, the appeal can be filed within 180 days from the day the claim was initially processed and you'll need a letter while you are appealing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is there any fax number?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] It got
[CUSTOMER][NEUTRAL] Your call is cutting in between. I'm sorry for that.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any attention to put on?
[AGENT][NEUTRAL] Claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And I'm calling
[CUSTOMER][NEUTRAL] 17
[CUSTOMER][NEUTRAL] And can I get the spelling of your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] And can I get the call reference number?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name and today's date.
[AGENT][NEUTRAL] Is there anything else I can help you with, Ms. [PII] before we go?
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] No I got the details. Thank you so much for assisting me. Have a nice day take care. Bye bye.
[AGENT][POSITIVE] You have a great day too, and thanks for calling APL bye bye Miss [PII].