AccountId: 011433970860
ContactId: 3284be71-9c69-4fa2-aec6-cc101543fef4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 519400 ms
Total Talk Time (AGENT): 126648 ms
Total Talk Time (CUSTOMER): 126042 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/3284be71-9c69-4fa2-aec6-cc101543fef4_20250225T16:44_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from the provider's office to look upon the claim. So can you help me with that? And can you just spell your name for me, please?
[AGENT][NEUTRAL] Sure, that's [PII]. That initial is [PII]. And yes, Ms. [PII], I can assist you with claim status. I need a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] So the callback number will be [PII]. It's a direct line.
[AGENT][NEUTRAL] Mm thank you and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, it is 021-73249.
[AGENT][NEUTRAL] And [PII], you're calling from which facility from my location?
[CUSTOMER][NEUTRAL] I'm not able to
[CUSTOMER][NEUTRAL] I'm so sorry, but your voice is getting break in between, so can you just check your connection?
[AGENT][NEUTRAL] What's the name of the facility, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yeah, it is Virginia Cancer Institute.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, so the name of the patient is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah, it is [PII] with the bill amount $500 even.
[AGENT][NEUTRAL] OK. [PII] [PII] for 500. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Let me see if I can find this claim for you. I'm gonna put you on a brief hold so I can search for this claim, OK? One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] before that we have submitted an appeal on this claim on [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So you need the appeal status or the claim status?
[CUSTOMER][NEUTRAL] We both, actually both.
[AGENT][NEUTRAL] Both OK, let me see what I can find for that data service. OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding and being patient for me, Ms. [PII]. OK, so we, we have not received the appeal. We have not received the appeal. I did find the claim. Uh, now, the claim has been processed and denied stating that um the service is not covered when performed in a doctor's office or a clinic.
[CUSTOMER][NEUTRAL] OK. But when it is denied?
[AGENT][NEUTRAL] OK, it was received [PII], processed [PII].
[CUSTOMER][NEUTRAL] 1 2nd.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. So, as it was denied previously as well, so we have submitted the
[CUSTOMER][NEUTRAL] Appeal through fax. So can you just verify the fax number? Is it [PII]?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] Yes, so can you just check me by 121 to 120 to any of the days you received any appeal?
[AGENT][NEGATIVE] I checked that's why you was on hold because I was checking on that. We have not received anything else than the claim that was processed and denied. Mhm.
[CUSTOMER][NEUTRAL] Yeah, I well.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Uh, can we submit the appeal again?
[AGENT][NEUTRAL] Yes, you can submit an appeal again. Um, you have 160 days from the decision date.
[AGENT][NEUTRAL] 180 days. I'm sorry from the decision name 180.
[CUSTOMER][NEUTRAL] 116.
[CUSTOMER][NEUTRAL] 180 days from [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Just a moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, we are still on the timely filing. We can submit it. So, the fax number is [PII]. What will be the attention if there is any attention?
[AGENT][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] Appeals department or claims department and just make sure to put a 1 in front of the 877 so it's 18773659423.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Just the call reference I required.
[AGENT][NEUTRAL] No, and we don't have reference numbers. We use our names.
[CUSTOMER][NEUTRAL] OK, I can take it as your name and today's date, is that correct?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][POSITIVE] OK. Thank you so much for this much of information given by you. Have a great day and stay safe. Bye-bye.
[AGENT][NEUTRAL] Hm.
[AGENT][POSITIVE] You're as well, and thank you for calling APR. Have a good day, Ms. [PII].
[CUSTOMER][NEUTRAL] OK.