AccountId: 011433970860
ContactId: 2a26a32b-9f5c-4f02-8f87-e8dc6ccb36b5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 213669 ms
Total Talk Time (AGENT): 89492 ms
Total Talk Time (CUSTOMER): 69650 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/2a26a32b-9f5c-4f02-8f87-e8dc6ccb36b5_20250210T16:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, hi [PII]. My first name is [PII], my last name is [PII] calling you from the provider's office looking for claim status.
[AGENT][NEUTRAL] OK, I can check in a claim for you, [PII]. Uh, can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] Uh, yes, the call back number is [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, yes, the patient's ID is 02486182.
[AGENT][NEUTRAL] OK, thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII] and the first name is [PII]. Last name is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. So what was the date of service for this client, please?
[CUSTOMER][NEUTRAL] [PII] total charge is $730 even.
[AGENT][NEUTRAL] I'm sorry, that was $730 even?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK thank you one moment please.
[AGENT][NEUTRAL] What was the name of the provider's office this was with [PII]?
[CUSTOMER][NEUTRAL] Uh, this is calling from.
[CUSTOMER][NEUTRAL] Saint Francis Hospital.
[AGENT][NEUTRAL] Got it. OK. Bear with me just a moment.
[AGENT][NEUTRAL] OK, so we did receive this claim, [PII]. Uh, we were unable to pay a benefit as this was not a covered diagnostic test under this policy.
[CUSTOMER][NEUTRAL] So is it uh something which we need to change uh the diagnosis code?
[AGENT][NEUTRAL] Um, so there's specific uh diagnostic tests that are covered under this policy, such as MRI, CAT scans, uh, CT scans, sleep studies. Um, it appears this is not one of those covered diagnostic tests.
[CUSTOMER][NEUTRAL] When did you receive the claim?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a minute, let's see, so this claim was received [PII], and it was processed on [PII].
[CUSTOMER][NEUTRAL] And the claim number.
[AGENT][NEUTRAL] That is 352-572-8.
[CUSTOMER][NEUTRAL] And uh what is the corrected claim timely funding limit.
[AGENT][NEUTRAL] There is no timely filing limit. Um, if you'd like to appeal that would be within 180 days.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, uh, thank you so much and do you have any reference number?
[AGENT][NEUTRAL] It would just be my first name, last initial and today's date. Uh, so my name is spelled [PII] Last [PII] is [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] Uh, no, that's all I need. Thank you so much and have a very pleasant day.
[AGENT][POSITIVE] OK, of course, yeah, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] OK bye.