AccountId: 011433970860
ContactId: 3faee56a-b25c-4c7a-8032-b0ef20310b75
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 543090 ms
Total Talk Time (AGENT): 163687 ms
Total Talk Time (CUSTOMER): 123621 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/3faee56a-b25c-4c7a-8032-b0ef20310b75_20250403T14:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling for our office to check on the claim status. Please note this call will be recorded and monitored for quality and training purposes while today.
[AGENT][NEUTRAL] OK, thank you, [PII]. I can help you with claim status. Can I please get your callback number, sir?
[CUSTOMER][NEUTRAL] Sure, that is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure. The policy number is 024786772. [PII], [PII].
[AGENT][NEUTRAL] OK, let me pull in that policy real quick.
[CUSTOMER][NEUTRAL] Sure. And then meanwhile, could you please spell out the name and the last name initial?
[AGENT][NEUTRAL] It's uh [PII] and the last initial is [PII]
[CUSTOMER][NEGATIVE] No thank you.
[AGENT][NEUTRAL] Thank you. And then what is the um data service for [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the charge amount please?
[CUSTOMER][NEUTRAL] $222 even.
[AGENT][NEUTRAL] OK, and what's the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Sure. And that is a moment that's loading.
[CUSTOMER][NEUTRAL] $95.25.
[AGENT][NEUTRAL] Thank you, sir. And can you please give me the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Minute clinic, diagnostic of South Carolina.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold [PII] while I look up this claim and I will be right back.
[CUSTOMER][POSITIVE] Sure, please take your time. Thank you.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Minute clinic.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. I've got the claim pulled up. The claim number is 3554873.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] And the claim was denied because there was no charge service. This policy does not provide a benefit for services in which.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Anger.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's uh not covered under the patient plan or the product contract?
[AGENT][NEUTRAL] Both.
[AGENT][NEUTRAL] No charges were incurred. There was nothing to pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] And once again that is 3554873.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Got it. And when the pay claim received date?
[AGENT][NEUTRAL] OK, let me look for that real quick for you.
[AGENT][NEUTRAL] The claim was received on [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] The number
[CUSTOMER][NEUTRAL] Got it. So in this case, can consider an appeal?
[AGENT][NEUTRAL] I'm sorry, can you repeat the question?
[CUSTOMER][NEUTRAL] Can we submit an appeal for this denial?
[AGENT][NEUTRAL] Yes, you can always submit appeal at um you have to have it within 180 days from the date the claim was initially processed and you'll also need to send a letter as to why you want to appeal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. And when the appeals mailing at the same time limit?
[AGENT][NEUTRAL] It's 180 days from the date the claim was initially processed.
[AGENT][NEUTRAL] And the appeal is the same address as the claims address. It's [PII]. That's in.
[AGENT][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] it
[CUSTOMER][NEUTRAL] Got it. And so, could you please confirm the EOB address?
[AGENT][NEUTRAL] The EOB address that it was sent to?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Let me pull up the EOB real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] It's gonna be just a minute while the computer pulls it up.
[CUSTOMER][NEUTRAL] And then we have a
[CUSTOMER][NEUTRAL] Sure. And we will receive a letter from you, but in that mentioned that this is not a bill. So is that the UOB?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That would be the EOB.
[CUSTOMER][NEUTRAL] OK, so that's a UB.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] OK, got it. I think I have that.
[CUSTOMER][NEUTRAL] And in this, uh, the dinner reason is mentioned as non-covered service and this product does, does not have it, OK?
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] No, it's denied because there's no charges incurred. There's no charges to pay.
[AGENT][NEGATIVE] Everything is 0.
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Got it.
[CUSTOMER][NEUTRAL] So instead of the appeal, can we send the correctly?
[AGENT][NEUTRAL] You can send a claim correction there's no time limit for that, but you'll also need a letter as to why you want to correct the claim.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you. And I'm ready for the call reference number.
[AGENT][NEUTRAL] OK, you can use my name [PII]
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][POSITIVE] Got it. Thank you. Go. We submit the, submit an appeal with the letter to process claim. Thank you. Bye-bye. Take care. Have a nice day.
[AGENT][POSITIVE] You have a good day too, [PII], we appreciate you calling APL. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] No, thanks for asking that.
[AGENT][POSITIVE] OK, thank you. You have a good day and thanks for calling APL sir. Bye-bye.