AccountId: 011433970860
ContactId: 0b6b793a-b5cf-4c25-a345-69ceee1cc6f5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 229020 ms
Total Talk Time (AGENT): 73762 ms
Total Talk Time (CUSTOMER): 75710 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/0b6b793a-b5cf-4c25-a345-69ceee1cc6f5_20250129T23:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and I'm calling for cardiovascular medicine associate to check on a client status.
[AGENT][NEUTRAL] All right, [PII], I'm happy to check on a claim. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure, and please be inform me that this call is being recorded and monitored for the quality and training purpose. number ID number is.
[CUSTOMER][NEUTRAL] 020
[CUSTOMER][NEUTRAL] 133
[CUSTOMER][NEUTRAL] 21
[CUSTOMER][NEUTRAL] M as in Mike, L as in Larry, number 8.
[AGENT][NEUTRAL] All right, thank you for that. And then can I get the patient name and date of birth?
[CUSTOMER][NEUTRAL] My name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and then what's the date of service?
[CUSTOMER][NEUTRAL] Sure, the service is [PII]. And this is for the total charge amount of
[CUSTOMER][NEUTRAL] $190 even 190.
[AGENT][NEUTRAL] All right, thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, so it looks like we did receive this claim claim was received [PII].
[AGENT][NEUTRAL] A claim was denied. Office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so it was reviewed on [PII] and then on [PII] as it non-covered service based on the patient plan, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] May I know the claim number?
[AGENT][NEUTRAL] 351-943-2.
[CUSTOMER][NEUTRAL] For document purpose, may I know the appeal mailing address?
[AGENT][NEUTRAL] A PO mail mailing address is going to be [PII].
[AGENT][NEUTRAL] That's in [PII] City, [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] [PII]. Attention to appeals.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] And the timely filing limit?
[AGENT][NEUTRAL] Appeals must be filed within 180 days of the decision.
[CUSTOMER][NEUTRAL] OK. 180 days from the denied date and you said the denied date is on [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, give me a minute. Let me check if I receive any payment for the CPT code previously.
[AGENT][NEUTRAL] No, there was not.
[CUSTOMER][NEUTRAL] OK, still checking.
[CUSTOMER][NEUTRAL] OK. May I have the call reference number?
[AGENT][NEUTRAL] Call references my name with my last initial in today's date. My name is [PII], that's [PII] Last initial is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much for your, [PII]. Have a wonderful day.
[AGENT][POSITIVE] You're welcome. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.