AccountId: 011433970860
ContactId: 3abfcab5-c02f-4365-babf-9e0dc2e2a6dc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 764919 ms
Total Talk Time (AGENT): 243804 ms
Total Talk Time (CUSTOMER): 221469 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/3abfcab5-c02f-4365-babf-9e0dc2e2a6dc_20250303T15:37_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm [PII] calling from Portal office on behalf of gas from [PII] to check my claim status.
[AGENT][NEUTRAL] OK, then you're needing claim status, is that correct?
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII] and the direct line.
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on today?
[CUSTOMER][NEUTRAL] I just have 2 claims for the day.
[AGENT][NEUTRAL] OK. Are they for the same patient, or is it one day the service for 2 patients?
[CUSTOMER][NEUTRAL] It's one data service for the 2 patients.
[AGENT][NEUTRAL] OK [PII], so yes, I can help you and you will use my name that I gave you along with today's date as your call reference number?
[AGENT][NEUTRAL] Also, any information that I provide for you, [PII] will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And then lastly, if we do have the claims on file and you need a copy of the explanation of benefits, you may go to our portal and print that and our portal website is secured. [PII].
[CUSTOMER][POSITIVE] OK, thanks for that.
[AGENT][NEUTRAL] OK, you're welcome. So what is the first patient's policy number?
[CUSTOMER][NEUTRAL] The first question's policy number is 022.
[CUSTOMER][NEUTRAL] 623
[CUSTOMER][NEUTRAL] 80 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[AGENT][NEUTRAL] And any information down as I stated would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is.
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you, and the date of service and total bill amount for her, please.
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII], but the charge of $175 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was received. The received date was [PII].
[AGENT][NEUTRAL] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] The claim number is 3,542,440.
[AGENT][NEUTRAL] And the reason for the denial states office visits are not covered.
[AGENT][NEUTRAL] By the above numbered policy. The member's plan does not cover office visits.
[AGENT][NEUTRAL] And is there any other information that you need on this policy, [PII]?
[CUSTOMER][NEUTRAL] 112.
[CUSTOMER][NEUTRAL] As you said the flying you on [PII] and denied on [PII] or [PII] as office visits are not covered, right?
[AGENT][POSITIVE] Yes, sir, that is correct.
[CUSTOMER][NEUTRAL] OK, and could you please repeat the claim number?
[AGENT][NEUTRAL] 354-2440
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 3,542,440, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And may I know what is the reason the client, the patient do not cover the office per say.
[AGENT][NEUTRAL] This member's plan, this is a supplemental policy, and the supplemental policy does not cover office visits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I can't see that um.
[CUSTOMER][NEUTRAL] Aetna have paid the claim as primary. So if I submit the claim with the primary EOB, is that possible to be paid and process to be paid?
[AGENT][NEUTRAL] Again, on this policy, this is not major medical insurance. This is a supplemental plan and the supplemental plan, the member's plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Does not cover office visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is there a mailing address or a fax number to send it off you?
[AGENT][NEUTRAL] And appeal must be sent to [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] And again it will need to be put to attention appeals department.
[AGENT][NEUTRAL] And it must be filed within 180 days from the date of the decision.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And could you please repeat the zip once more?
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] You said the address is [PII].
[CUSTOMER][NEUTRAL] [PII] and the family funding day limit is 180 days from the date of tomorrow.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, thanks for that, and we can move to the next patient. Is there a reference number for this patient?
[AGENT][NEUTRAL] As I explained, you would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] You said your name is [PII], right?
[AGENT][POSITIVE] [PII], that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thanks for that and we can move on to the next time.
[AGENT][NEUTRAL] What is the next policy number?
[CUSTOMER][NEUTRAL] And the next item number is 0.
[CUSTOMER][NEUTRAL] 24
[CUSTOMER][NEUTRAL] 248-84 M as in Mike L as in Lima number 8.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount.
[CUSTOMER][NEUTRAL] Telecom services [PII] with a bill charge of $215.14.
[AGENT][NEUTRAL] And that was 227 2024 for 215.14. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so this claim was also received the received date was [PII].
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] I'm sorry for the interruption. I can see that the denial on the client and it's the same denial like the previous client, the patient did not cover the office, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And we have sent an appeal on the fine on [PII] with the Medicare records to the mailing address via books [PII].
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] OK, that is a very old claims mailing address that was never received.
[AGENT][NEUTRAL] The correct mailing address is the address that I provided for you.
[CUSTOMER][NEUTRAL] OK, is there a fax number to send it up to.
[AGENT][NEUTRAL] Um, the appeal must have been filed within 180 days from the date of the decision. This claim was reviewed and processed on [PII].
[CUSTOMER][NEUTRAL] Yeah, I got that. I ask, is there any fax number to send to my people?
[AGENT][NEUTRAL] Appeals can be sent to [PII]. Attention appeals department, but the tape, the time the excuse me, the filing limit for an appeal has expired.
[CUSTOMER][NEUTRAL] Yeah, got that. Can you please repeat the fact once more.
[AGENT][NEUTRAL] [PII] attention appeals.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I repeat that [PII], right?
[AGENT][NEUTRAL] Attention appeals department.
[CUSTOMER][NEUTRAL] Attention of his department.
[CUSTOMER][POSITIVE] OK, thanks for that.
[CUSTOMER][POSITIVE] OK, and I'll send that to you shortly. Thanks for that.
[AGENT][POSITIVE] Yes, sir, you're welcome. And is there anything else I can help you with?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] No, that's it for today. Thanks for time us assistance. Have a great day. Bye-bye.
[AGENT][POSITIVE] I hope you have a great day too, [PII], and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][POSITIVE] Uh-huh, you're welcome. Bye-bye.