AccountId: 011433970860
ContactId: 2b4e4e37-d90b-447f-9894-0faa2d56606c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 526640 ms
Total Talk Time (AGENT): 143302 ms
Total Talk Time (CUSTOMER): 173406 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/2b4e4e37-d90b-447f-9894-0faa2d56606c_20250214T18:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling for Arkansoring Valley Health Center. This call is being recorded and monitored for quality and training purposes, and this call is meant to check on a claim status.
[AGENT][POSITIVE] OK, I can help you spell your name for me, please.
[CUSTOMER][NEUTRAL] Yeah, my name is [PII].
[AGENT][NEUTRAL] Oh, TO [PII].
[CUSTOMER][NEUTRAL] Yeah, could you please spell your name, the last name and sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] And what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] OK, yeah, that will be 01986373.
[AGENT][NEUTRAL] Can I get a phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, that will be [PII] and it's a direct line.
[AGENT][NEUTRAL] OK. And my name is [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] First initial last name is [PII]. Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sorry, are you on the line?
[AGENT][POSITIVE] Yes, I'm pulling up the information. One moment please. I'll be right back with you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the date of birth is.
[CUSTOMER][NEUTRAL] [PII]. And the first name is [PII], last name is [PII].
[AGENT][NEUTRAL] OK, and you said that you're checking a claim status?
[CUSTOMER][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] OK, I can help with that information. What is the date of service and the total charge?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII] with the bill amount of just give me one second for the bill amount.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Just give me one second, the bill amount.
[CUSTOMER][NEUTRAL] Yeah yeah.
[CUSTOMER][POSITIVE] Yeah, thanks for being patient. The bill amount is $240 even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm. And I just want to inform the most recent claim submission was on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Showing the claim was received [PII], processed [PII].
[AGENT][NEUTRAL] Uh, no payment was made as the office visit is not covered by the patient's policy. I'm showing this, uh, claim processed under claim number 354.
[AGENT][NEUTRAL] 0922.
[AGENT][NEUTRAL] And you can also check status online at [PII]. Did you have any other questions?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry, could you please repeat the pet name?
[AGENT][NEUTRAL] Repeat what name?
[CUSTOMER][NEUTRAL] The website you provided right now?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The website you provided right now where we can find the claim status.
[AGENT][NEUTRAL] OK, I'm not understanding what you're asking.
[CUSTOMER][NEUTRAL] Just now you said to some website to see the claim status. I just want to repeat that.
[AGENT][NEUTRAL] The the claim was denied. Office visits are not covered by the patient's policy.
[CUSTOMER][NEUTRAL] OK, just give me 1 2nd.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK. Could you please provide me the mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, the zip code is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII], correct. [PII].
[CUSTOMER][NEUTRAL] OK. Uh, I will confirm. [PII] [PII]. OK. [PII].
[AGENT][NEUTRAL] The [PII] is the [PII].
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and the timely filing is 18 days from the date of service.
[AGENT][NEUTRAL] timely filing to submit a claim or to submit an appeal?
[CUSTOMER][NEUTRAL] Apple
[AGENT][NEGATIVE] 180 days from the date it was denied.
[CUSTOMER][NEUTRAL] OK. Is there any intention for the bill?
[AGENT][NEUTRAL] Attention appeals.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is any special form needed for this appeal?
[AGENT][NEUTRAL] Just submit documentation pertinent to as pertinent as to why the claim is being appealed. I mean, it's not covered by the policy, so more than likely the appeal will be upheld, but you're more than welcome to submit it.
[CUSTOMER][NEUTRAL] Mhm. And I just want to confirm, do you need the denial you'll be along with the pill?
[AGENT][NEUTRAL] That you could submit it if you like, and I meant the decision would be upheld because the service is not covered by the patient's policy.
[CUSTOMER][NEUTRAL] OK, so dinner will be is not uh mandated, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Denied UB is not mandatory, right?
[AGENT][NEUTRAL] It's not, but you do need to put the pertinent information in there so we'll know what we're appealing.
[AGENT][NEUTRAL] Revealing the PL4 yeah.
[CUSTOMER][NEUTRAL] Mhm. Yeah, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Anything else?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Could you please tell me the call reference number for this call?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][POSITIVE] Mhm. Yeah, OK, then that's all about. Have a great day.
[AGENT][POSITIVE] Thank you for calling APL [PII]. Have a good day as well.
[AGENT][NEUTRAL] [PII], I still have you holding on the line. Did you have any other questions?