AccountId: 011433970860
ContactId: 11288a49-d6ee-4542-bca4-bfbdfb8fdbfb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 474700 ms
Total Talk Time (AGENT): 143027 ms
Total Talk Time (CUSTOMER): 137617 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/11288a49-d6ee-4542-bca4-bfbdfb8fdbfb_20250605T21:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, hi, this is [PII] calling from provider's office. Check on claim status.
[AGENT][NEUTRAL] I can help you with claim status, [PII]. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] It's a direct line?
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And what is the policy number?
[CUSTOMER][NEUTRAL] It is 022-03089. I'm sorry, it's M like Mike.
[CUSTOMER][NEUTRAL] L. like Lima, 8.
[AGENT][NEUTRAL] OK, give me just one moment.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] It's [PII] and the birth date is [PII].
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] Mhm, you're very welcome.
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] I do have the date of service. It is [PII]. The claim was billed for $250 even.
[AGENT][NEUTRAL] You said 25,050?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, give me just a moment to look that up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, it looks like we received this claim on [PII].
[AGENT][NEUTRAL] It was processed on the same day, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number 3587.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] 281.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and let me just verify that is at 358-7281?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And it looks like that claim was denied because office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Is member is responsible for this?
[AGENT][NEUTRAL] Uh, we don't determine patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. And can I have the member's plan type?
[AGENT][NEUTRAL] I'm sorry, the numbers what?
[CUSTOMER][NEUTRAL] It's the policy type, the coverage type.
[AGENT][NEUTRAL] Uh, this is Secondary Gap Insurance.
[CUSTOMER][NEUTRAL] OK, uh, no, no, I, I wanna know is that a PPO or a Medicaid plan or?
[CUSTOMER][NEUTRAL] A Medicare supplementary or so what is the type of plan?
[AGENT][NEUTRAL] Uh, it's neither of those. We are not in network. Uh, we are just secondary, um, medical insurance. We're not major medical.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This is just a supplement.
[AGENT][NEUTRAL] To their major medical.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So, is there a appeal address?
[CUSTOMER][NEUTRAL] Can I have that?
[AGENT][NEUTRAL] Uh, yes, give me just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. It will be [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Attention appeal department.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] In [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah, it's the [PII]. And do you have a fax number for NPO?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Fax number again will be attention appeals department.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Thank you. And for an appeal, is there any specific form need to be attached?
[AGENT][NEGATIVE] Um, I don't believe so, no.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And the.
[CUSTOMER][NEUTRAL] Could you fax us the copy of an EOB?
[AGENT][NEUTRAL] Give me just one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Give me just one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Did you want attention [PII] or did you want it um to someone else?
[CUSTOMER][NEUTRAL] Uh, you can put that, no, you can put that intention to [PII] and yeah, that would do.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Give me just one moment.
[AGENT][NEUTRAL] And what is a good fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And to verify, I have [PII], correct?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I just sent that fax to you.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, thank you. And can, when can we receive the fax?
[AGENT][NEUTRAL] Uh, it should be within a few minutes. Uh, give it up to an hour though.
[CUSTOMER][NEUTRAL] I wanna get
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, no problem and can I have the reference number for our call?
[AGENT][NEUTRAL] So we don't have reference numbers, but you can use my name and last initial in today's date. So [PII], last initial [PII] and today's date.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank you, thank you so much and I wish you have a great rest of your day. Thank you, yeah.
[AGENT][POSITIVE] Great. Thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Have a great day bye bye.