AccountId: 011433970860
ContactId: 1dbcd35c-d25f-4e00-97e6-f2e2e0e405e7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 285750 ms
Total Talk Time (AGENT): 127632 ms
Total Talk Time (CUSTOMER): 115541 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/1dbcd35c-d25f-4e00-97e6-f2e2e0e405e7_20250416T12:57_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from provider's office to look for the claim status.
[AGENT][NEUTRAL] I can verify claim status. May I have a policy number?
[CUSTOMER][NEUTRAL] Yes, of course. Uh, it is.
[CUSTOMER][NEUTRAL] 01845835 M like Mike L like Lima 8.
[AGENT][POSITIVE] Thank you. May I have a good callback number for you, [PII]?
[CUSTOMER][NEUTRAL] Yes, of course. It is [PII]. It's a direct line. Uh, if you don't mind, could you spell your name for me?
[AGENT][POSITIVE] Thank you, ma'am.
[AGENT][NEUTRAL] [PII] Last initial is [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes. Uh, it is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. May I have a date of service?
[CUSTOMER][NEUTRAL] Yes. Uh, it is [PII], and the bill amount is $639 even.
[AGENT][NEUTRAL] Thank you. For future reference, you may visit our website at [PII] check claim status as well.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] And the total bill amount is 630 or 639.
[CUSTOMER][NEUTRAL] 639. I have another uh bill amount for the same date of service. It is 630 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like for 630, it processed under claim number 347-8957.
[AGENT][NEGATIVE] No benefits are payable. They do not have the office treatment benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And for
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 639. It processed under claim number 347-8954. No benefits are payable. It do not have the office treatment benefit.
[AGENT][NEUTRAL] And it looks like both of the claims processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. So do not, due to uh non-covered charges, right, as per the member's plan?
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Uh, may I know whether the claim process as primary or secondary?
[AGENT][NEUTRAL] This claim is secondary.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] Uh, can we file an appeal to prove the medical necessity for this member?
[AGENT][NEUTRAL] Yes, you appeal is 180 days from the date that it was denied, but I'll give you the mailing address for an appeal.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, I'm ready for that.
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. What is it, OK. Do you have any fax number to submit an appeal?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] The fax number will be [PII].
[AGENT][NEUTRAL] [PII], I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Um, can I get the mailing address?
[AGENT][NEUTRAL] It will be the same address.
[CUSTOMER][NEUTRAL] OK, what is the time falling for that?
[AGENT][NEUTRAL] There's 180 days to submit an appeal.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you so much for that one. can I get the call reference number?
[AGENT][NEUTRAL] It will be my name which is [PII]. Last initial is [PII] along with today's date.
[CUSTOMER][POSITIVE] Mhm. Thank you so much, [PII]. Uh, thank you very much for your assistance. Have a great day and bye for now.
[AGENT][POSITIVE] [PII], you're so welcome. And thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.