AccountId: 011433970860
ContactId: 0e49fa62-b3e2-4839-a940-d64627152acd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274260 ms
Total Talk Time (AGENT): 57371 ms
Total Talk Time (CUSTOMER): 133905 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/0e49fa62-b3e2-4839-a940-d64627152acd_20250507T15:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII], and I'm calling from faculty physicians and surgeons. I just called a few minutes ago regarding a claim that I needed a clarification on, and I was wondering, I completely forgot to ask if I were to submit an appeal, um, what address would I submit that to?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Um, it's the [PII].
[CUSTOMER][POSITIVE] [PII] let me just double check here I have everything that I need.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, so it's American Public Li [PII]. I was wondering, um, yeah, I have you look into this, um, before when I submit the appeal, I wanna make sure that it's correct what I'm gonna go ahead and attach to my appeal.
[AGENT][NEUTRAL] OK, do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, I have it. It's 02504362.
[AGENT][POSITIVE] And you have a good callback number, [PII], in case we're disconnected?
[CUSTOMER][NEUTRAL] 9 of course [PII].
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is gonna be um [PII]. Last name [PII] birthday [PII].
[AGENT][NEUTRAL] OK. And then what were you checking on for the appeal?
[CUSTOMER][NEUTRAL] Um, let's see, because I, when I just called a few minutes ago, they were saying that um the client didn't get was not processed due to the surgery not um being missing.
[CUSTOMER][POSITIVE] But I do see that we did bill it on the [PII] and the claim was processed and paid.
[AGENT][NEUTRAL] Uh, what was the date of service?
[CUSTOMER][NEUTRAL] Um, the data service that was denied was [PII] for the anesthesia.
[CUSTOMER][NEUTRAL] For CPT code 01967.
[AGENT][NEUTRAL] OK, let me look at it.
[CUSTOMER][NEUTRAL] Sorry, I didn't realize until I hung up and I was like oh my god, I could have asked you that.
[AGENT][NEUTRAL] OK. And you said there was a surgery benefit that was paid for the same date of service?
[CUSTOMER][NEUTRAL] Um, no, it was paid on the [PII].
[CUSTOMER][NEUTRAL] Ford service [PII].
[CUSTOMER][NEUTRAL] For the delivery.
[AGENT][NEUTRAL] OK. I guess that's the discrepancy on our end is that you're billing for anesthesia on [PII] and then the surgery date is [PII].
[AGENT][NEUTRAL] You have to be honest.
[CUSTOMER][NEUTRAL] The yeah, the delivery date was on the [PII].
[AGENT][NEUTRAL] OK, yeah, I see this surgery on the [PII], um.
[CUSTOMER][NEUTRAL] Yeah, because I was looking at the anesthesia report and it says it was given to her on the [PII] at at [PII] and it stopped on the [PII], [PII] when she delivered.
[CUSTOMER][NEUTRAL] But I just wanted to make sure that.
[CUSTOMER][POSITIVE] That's what we needed.
[CUSTOMER][NEUTRAL] For my appeal.
[AGENT][NEUTRAL] Yes, yeah, if you can include the op report that shows the times, yeah, yeah.
[CUSTOMER][NEUTRAL] Submit the medical records.
[CUSTOMER][NEUTRAL] I definitely will do that. OK, that's what I wanted, yeah, I was OK. I wanted to make sure before I submit the appeal that I gave the times on there on anesthesia.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] That would be perfect, yeah.
[CUSTOMER][POSITIVE] Yes, OK, thank you for looking into that and your name again was?
[AGENT][NEUTRAL] Uh, my name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the reference number, it would, it's the same thing in your name and today's day, right?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][POSITIVE] Got it thank you you have a good day.
[AGENT][POSITIVE] Thank you, [PII]. Have a good day too. Thanks for calling IPL. Bye bye.
[CUSTOMER][POSITIVE] Mhm likewise bye bye thank you.