AccountId: 011433970860
ContactId: 0cb85eea-f8df-47b0-8ddb-ff107d0f356d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 391829 ms
Total Talk Time (AGENT): 152307 ms
Total Talk Time (CUSTOMER): 123603 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/0cb85eea-f8df-47b0-8ddb-ff107d0f356d_20250107T21:12_UTC.wav
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[AGENT][NEUTRAL] Field, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. This is [PII]. Last initial is [PII]. I'm calling from Community Ambulance provider office. I need to check a claim status. So could you please help me?
[AGENT][NEUTRAL] Yes, [PII], I can help you with claim status and in case this call is disconnected, may I have your callback number?
[CUSTOMER][NEUTRAL] Uh, sure. The callback number is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And your name is [PII] if I'm not wrong, right?
[AGENT][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] And may I please have the patient's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, patient policy number is 018669.
[CUSTOMER][NEUTRAL] 50
[CUSTOMER][NEUTRAL] M as in Mary, [PII] as in Lima, 7.
[AGENT][NEUTRAL] Thank you, and that number is 01866950 [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And may I have the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, patient name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] Thank you and may I have the date of service and the bill amount of the claim?
[CUSTOMER][NEUTRAL] Date of service is [PII] and bill amount $1,276.12.
[AGENT][NEUTRAL] Thank you, so that's for data service of [PII] and the amount of $1,276.12.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hello. OK. Let me take a look.
[CUSTOMER][POSITIVE] Yes, [PII], you're right.
[AGENT][NEUTRAL] OK, I show we did receive that claim in. I show that claim was processed.
[AGENT][NEGATIVE] Looks like this claim was processed on, it was received on [PII], processed on [PII]. Nothing was paid on this claim because we pay no benefits for any expenses which result from alcoholism or drug use.
[AGENT][NEGATIVE] Therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] OK. So, the payment.
[AGENT][NEUTRAL] Would you like the claim number?
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][NEUTRAL] The claim number is 3511156.
[CUSTOMER][NEUTRAL] OK. It is 351-115-6, right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK. Uh, [PII], actually, I have one question. Like what is the reason that claim was not paid? Like, uh,
[AGENT][NEUTRAL] It looks like based off the diagnosis that was due, it was based off the diagnosis codes, the policy is not covered due to drug use. And those, that was one of the diagnosis codes listed on the information that we received.
[CUSTOMER][NEGATIVE] Patient is not that good.
[CUSTOMER][NEUTRAL] Uh, OK. And diagnosis build is, uh, let me check.
[CUSTOMER][NEUTRAL] If an anxiety disorder, cannabis use, OK.
[CUSTOMER][NEUTRAL] Uh, [PII], could you please suggest like any other diagnosis can be built so we can resubmit corrected claim.
[AGENT][NEUTRAL] I can't suggest anything regarding if these are the correct diagnosis codes, then there wouldn't be anything further. You do have the option to submit an appeal if you disagree with the decision, you can submit that appeal into us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And if you want to submit an appeal in that can be submitted to our, our mailing address, which is the PO box.
[CUSTOMER][NEUTRAL] OK, because.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And an appeal must be submitted from 180 days from the receipt of the the claim decision.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, uh, [PII], could you please confirm the PO box address again?
[AGENT][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] OK OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. [PII], is it possible that you can share the explanation of benefit on facts?
[AGENT][NEUTRAL] Yes, we can fax you a copy of the explanation of benefits and what is that fax number?
[CUSTOMER][NEUTRAL] OK. The fax number is
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And you can use extension.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So the fax number is [PII] and there's also an extension for the fax of [PII].
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][NEUTRAL] OK, I will get that faxed over to you. Do I just need to make it to your attention, [PII]?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And OK now may I please have a call reference number?
[AGENT][NEUTRAL] It'll be just my name and that's [PII] Is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Uh, no, no, thank you so much. Have a nice day.
[AGENT][POSITIVE] You're, you're welcome. You too. Thanks for calling APL. You have a good day as well. Mm bye.
[CUSTOMER][NEUTRAL] You too.