AccountId: 011433970860
ContactId: 238ed773-1196-4b79-950a-59d8e6410ecc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 827000 ms
Total Talk Time (AGENT): 238710 ms
Total Talk Time (CUSTOMER): 188567 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/238ed773-1196-4b79-950a-59d8e6410ecc_20250311T13:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from provider's office Texas Healthcare PLLC.
[AGENT][NEUTRAL] I'm sorry, what was your first name?
[CUSTOMER][NEUTRAL] Yeah, that's [PII].
[CUSTOMER][NEUTRAL] Spells as [PII].
[AGENT][POSITIVE] OK, that's good. Thank you.
[CUSTOMER][NEUTRAL] And the last name initial is [PII].
[AGENT][POSITIVE] OK, thank you. And what is a good callback number for you please, [PII]?
[CUSTOMER][NEUTRAL] Uh, OK. Before that, I would like to inform you this call is been recorded for quality and training purposes. Will that be OK for you?
[AGENT][NEUTRAL] That is fine.
[AGENT][NEUTRAL] What is your callback number?
[CUSTOMER][NEUTRAL] OK, callback number, yeah, it is [PII].
[CUSTOMER][NEUTRAL] And that's a direct line?
[AGENT][POSITIVE] Thank you. And how can I help you today, [PII]?
[CUSTOMER][NEUTRAL] Yeah, I'm calling for a claim of one of your members and.
[AGENT][NEUTRAL] How many you're needing claim status?
[CUSTOMER][NEUTRAL] The member I
[CUSTOMER][NEUTRAL] No, it's not for the claim status. It's uh regarding an appeal.
[AGENT][NEUTRAL] OK. And how many do you have?
[CUSTOMER][NEUTRAL] I just have only one.
[AGENT][NEUTRAL] OK, so you're checking an appeal status, is that correct?
[CUSTOMER][NEUTRAL] Um, yes.
[AGENT][NEUTRAL] Yes, I can help you with that. And what is the member's policy number?
[CUSTOMER][NEUTRAL] OK, member's ID is [PII].
[AGENT][POSITIVE] Thank you, one moment please.
[AGENT][NEUTRAL] And you said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and any information that I provide for you would be a verification of benefits and not a guarantee of payment. What is the patient's name please and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Give me just a couple of moments, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And Va, what is the data service and total bill amount, please?
[CUSTOMER][NEUTRAL] OK, date of service is uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the bill amounts
[CUSTOMER][NEUTRAL] Yes. The amount is $513 even.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, [PII]. So this was received on [PII], it was processed in on [PII].
[AGENT][NEUTRAL] The claim number.
[CUSTOMER][NEUTRAL] Mm sorry, can you repeat that again?
[AGENT][NEUTRAL] Which date? Both of them?
[CUSTOMER][NEUTRAL] Uh yes, uh, from the beginning.
[AGENT][NEUTRAL] It was received [PII].
[AGENT][NEUTRAL] Processed on [PII].
[AGENT][NEUTRAL] The claim number is for the appeal is 355.
[AGENT][NEUTRAL] 882 7.
[AGENT][NEUTRAL] And this was
[AGENT][NEGATIVE] Denied.
[CUSTOMER][NEUTRAL] OK, can you state the reason for the denial?
[AGENT][NEUTRAL] Just a moment and I'll pull up the letter that has been mailed to the provider.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna take a moment for this information to load for me just a moment.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you for your patience.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, I'm still
[AGENT][NEUTRAL] Pulling the information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I am very sorry, but I'm unable to pull the letter up to actually read the decision to you.
[AGENT][POSITIVE] Um, [PII], now I can try and connect you with someone who can possibly provide additional information to you if you would like. I can, I'll be happy to try that.
[AGENT][NEUTRAL] But a letter has been mailed.
[AGENT][NEUTRAL] To the provider with the remarks regarding the the appeal decision.
[CUSTOMER][NEUTRAL] OK, but we didn't receive the letter yet, so.
[CUSTOMER][NEUTRAL] It would be helpful if I get the information on call.
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] OK, I'm gonna place you on a brief hold for just actually give me just one moment.
[AGENT][NEUTRAL] OK, so if you will give me one whole moment, I will try and get you connected uh with someone, Vasco, but before I do that, is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] Mm, no. And uh uh can I get your name, please?
[AGENT][NEUTRAL] Again, my name is [PII].
[CUSTOMER][NEUTRAL] OK, got that.
[AGENT][POSITIVE] And then, OK. Well, if that is all then then I can help.
[AGENT][POSITIVE] You with um thank you for calling APO and I hope you have a very nice day.
[CUSTOMER][NEUTRAL] Yeah, you too.
[AGENT][POSITIVE] So one moment, please. Thank you.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Good morning. Thank you for calling American Public Life. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Well, hey, [PII], this is [PII]. How are you today?
[CUSTOMER][POSITIVE] Oh, I'm fine, thank you.
[AGENT][NEUTRAL] Well, that is good. So I have a provider on the line who was calling for an appeal status, and I cannot locate the letter that we've sent.
[CUSTOMER][NEUTRAL] OK, what is that policy number?
[AGENT][NEUTRAL] In on base. The policy number is 2394957.
[AGENT][NEUTRAL] For [PII].
[AGENT][NEUTRAL] And he says they haven't received the letter.
[CUSTOMER][NEUTRAL] OK, give me one minute let me.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Pull some information.
[AGENT][NEUTRAL] And he's just wanting to, you know.
[CUSTOMER][NEUTRAL] She may be. I may not have got to that letter yet. Let me look at my pending now. I don't have it in my pending. I got a couple that I had to move over to my pending because I haven't had time to get anything that. Give me a few minutes. Her name does sound familiar.
[AGENT][NEUTRAL] Uh uh.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Well,
[AGENT][NEUTRAL] that's not.
[CUSTOMER][NEUTRAL] I can't remember that [PII]e might not have we got changed so many steps anymore, and I bet you I did not get that in there. So let me go to my other site where I do my login for my appeals. So give me one minute.
[AGENT][NEUTRAL] OK, now here, but it's uh, OK, this [PII].
[CUSTOMER][NEUTRAL] Yeah, is that when it was looks like um we received something on [PII].
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] Hold on, here I'm still going through here. Give me one minute.
[AGENT][NEUTRAL] And you had told
[AGENT][NEUTRAL] Well, this is, this, what I found was.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Was it for the date of service of [PII]?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, I found it. Hold on, let me, let me put that letter in there. I just probably did not, I missed that step to hold on here and I'll get that letter.
[AGENT][NEUTRAL] OK. Could you just, can you go over that with him? He didn't, he says I didn't receive it. So, um, the
[CUSTOMER][NEUTRAL] they should have got it. Yes.
[CUSTOMER][NEGATIVE] They did not receive it. It was no.
[AGENT][NEUTRAL] Mhm. The gentleman on the line, his name is [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Let me write this down. [PII] what?
[AGENT][NEUTRAL] Sure
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] Uh-huh. And um
[CUSTOMER][NEUTRAL] And it is for, uh-huh.
[AGENT][NEUTRAL] Go ahead. And it is for the client.
[CUSTOMER][NEUTRAL] I was
[AGENT][NEUTRAL] Mhm. Go ahead and ask me what you were gonna ask me.
[CUSTOMER][NEUTRAL] What, what is, what is, what is, is it good service [PII]?
[AGENT][NEUTRAL] Yes, uh-huh.
[CUSTOMER][NEUTRAL] OK, OK, you can go ahead and transfer him.
[AGENT][POSITIVE] OK. Well, thank you so much, [PII], and I hope you have a great day.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][POSITIVE] Thank you, you too.
[AGENT][POSITIVE] Alright, thank you. Bye bye.
[CUSTOMER][NEUTRAL] OK