AccountId: 011433970860
ContactId: 1fb737c0-f18c-470a-a224-f75dddb66c08
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 351540 ms
Total Talk Time (AGENT): 136755 ms
Total Talk Time (CUSTOMER): 116325 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/1fb737c0-f18c-470a-a224-f75dddb66c08_20250131T19:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling you from provider's office to check on a claim status.
[AGENT][NEUTRAL] OK, I could check on a claim for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, the callback number is [PII].
[CUSTOMER][NEUTRAL] [PII] it's a direct number.
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Uh yes, I have. Can you please spell your name for the records?
[AGENT][NEUTRAL] Oh, sure, it's [PII]
[CUSTOMER][POSITIVE] OK, thank you so much, [PII]. Just a minute.
[AGENT][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] Um yes, it's uh 023.
[CUSTOMER][NEUTRAL] 77,560.
[AGENT][NEUTRAL] OK, and uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that, [PII]. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] Uh, just a minute. The date of service is, uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the bill amount please?
[CUSTOMER][NEUTRAL] $35,293.63.
[AGENT][POSITIVE] I'm sorry, that was, I'm so sorry. I kind of cut out there at the beginning, [PII], could you repeat that?
[CUSTOMER][NEUTRAL] It's 352-93.63.
[AGENT][POSITIVE] OK, got it, thank you one moment please.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, so we did receive this claim, [PII].
[AGENT][NEGATIVE] We were unable to pay a benefit as outpatient services are not covered under this policy.
[AGENT][NEGATIVE] It does not also does not provide any benefits for diagnostic testing.
[CUSTOMER][NEUTRAL] OK, just a minute.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, can I get the claim receipt date.
[AGENT][NEUTRAL] Yes, this claim was received [PII].
[AGENT][NEUTRAL] And it was processed July, yes, uh [PII].
[CUSTOMER][NEGATIVE] And it was denied on.
[CUSTOMER][NEUTRAL] OK, thank you so much and it is denied as an outpatient service was not covered under this policy, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Yeah, thank you so much for that and we don't have any information about this claim and we don't have any EO bill. Can you please fax me the copy of an EOB?
[AGENT][NEUTRAL] I can send that to you.
[AGENT][NEUTRAL] Of course what's that fax number for you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The fax number is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] attention to Victor V.
[AGENT][NEUTRAL] You said Victor V.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and I'm going to read that fax number back to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, perfect. uh, can I get the claim number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, it is 34.
[AGENT][NEUTRAL] 85,610.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Of course, yep, and I'll go ahead and get that, uh, you'll be sent to you now. Uh, you should get it here in maybe 10-15 minutes depending on how busy your machine is. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Cash.
[CUSTOMER][NEUTRAL] Uh, can I get the call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh so my name is spelled [PII]
[CUSTOMER][NEGATIVE] Yeah, thank you so much and I do forgot the one thing and uh it is showing that it's there for our patient service. It's not gonna covered under this policy means uh what we should do for this one.
[AGENT][NEUTRAL] Uh, what do you mean? I'm sorry.
[CUSTOMER][NEUTRAL] And what should we do for this, uh, we should send the appeal or is there any other policy is there for a member?
[AGENT][NEUTRAL] No, um, this policy is not going to cover either of the procedures that were listed under this claim.
[AGENT][NEUTRAL] And they don't have any other medical plans with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the member don't have any other insurance, right?
[AGENT][NEGATIVE] Not that I'm able to see, not with us.
[CUSTOMER][NEUTRAL] OK, can I get an appeal mailing address?
[AGENT][NEUTRAL] Uh, that would be the same as our client's address. It is [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah, and what's the time defining limit?
[AGENT][NEUTRAL] It is 180 days uh from the uh process date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, uh, thank you so much. Thank you, that's it for today.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Yeah have a great day bye.
[AGENT][POSITIVE] Thank you. Bye-bye.