AccountId: 011433970860
ContactId: 54617b23-68aa-4951-9982-43a0593a12db
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 623900 ms
Total Talk Time (AGENT): 296661 ms
Total Talk Time (CUSTOMER): 204234 ms
Interruptions: 5
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/54617b23-68aa-4951-9982-43a0593a12db_20250203T17:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. You're speaking with [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling on behalf of provider's office to check on the claim status. May I know your name, please?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] Can you spell it out?
[CUSTOMER][NEUTRAL] OK, busy. How are you busy?
[AGENT][NEUTRAL] OK, can you spell your first name, please?
[CUSTOMER][NEUTRAL] Yes, my first name is [PII] and the last name is [PII]
[AGENT][NEUTRAL] OK, [PII], give me your phone number just in case we get disconnected.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], what's the name of the providers you're calling from?
[CUSTOMER][NEUTRAL] To, to check on the claim status.
[AGENT][NEUTRAL] All right. May I have the policy number you're calling in reference to?
[CUSTOMER][NEUTRAL] Yes, 02474924.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the first name is [PII] and the last name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Alright, and you said you're calling checking claim status.
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] All right. What's that data service?
[CUSTOMER][NEUTRAL] Yeah, the date of service is, one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes. The first date of service is?
[CUSTOMER][NEUTRAL] [PII] with the total bill amount. This is the date range claim basically from [PII] to.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Oh, did you say [PII]?
[CUSTOMER][NEUTRAL] Yes, and from [PII], with the total bill amount, $4,274 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]. OK, let me see, do I see that? Hold on one moment.
[CUSTOMER][NEUTRAL] Yes. OK.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] On the [PII] and then look for it.
[AGENT][NEUTRAL] All right, let's see if this it. That's not it. OK. [PII], and let me see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm looking for you hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's not it. I don't see the date span from.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] that a bill on file for that amount. When was it submitted?
[CUSTOMER][NEUTRAL] Yes, can you see as an, uh,
[CUSTOMER][NEUTRAL] Can you repeat once again what you have repeated?
[AGENT][NEUTRAL] I did not see that data service on file for that provider's office for that amount. Can you tell me when was it submitted?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] The claim was submitted on.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII], sorry, [PII].
[AGENT][NEUTRAL] OK, [PII], but I don't see that on file for that date of service.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For that amount.
[AGENT][NEUTRAL] For that provider either, either for that provider. I can give you our fax number where you can submit the claim to.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, we have sent in an appeal on [PII].
[AGENT][NEUTRAL] OK, [PII]. OK, let me see, did we get anything and if you send in a pill, you would, it would have went to the pill department. So let me see.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] In October, Nope. OK. Can you hear me? Hello?
[CUSTOMER][NEUTRAL] Yes, I'm
[AGENT][NEGATIVE] OK, yeah, you keep cutting out. Your phone keeps cutting off.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, no, let's see. And what's the name of Provada again?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What's the name of the provider's office again?
[CUSTOMER][NEUTRAL] The provider's office name is Quest Care Hospitalist PLLC.
[AGENT][NEUTRAL] No, we don't have that on file. I don't see that on file for that data service for that provider.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I can give you the fax number where you can submit it, you said y'all submitted appeal, so if you submitted appeal, you should have a claim number. Do you have a claim number for?
[CUSTOMER][NEUTRAL] That is.
[CUSTOMER][NEUTRAL] One moment. Yes, I have a claim number. One moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, the claim number is 35142.
[AGENT][NEUTRAL] OK. What is it?
[CUSTOMER][NEUTRAL] 230. Yeah.
[AGENT][NEUTRAL] OK, 0, OK. 14. OK, here one right here. Let's see if that is.
[AGENT][NEUTRAL] And this is the this data service start [PII] for what I have they got 9/11 on this bill and not [PII], not 9 uh 12 like you put. Let me just see if this the bill for that amount. Give me one second.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh, they didn't put the total amount of the bill, but it was inpatient physician charges that was on this particular bill for that date of service and that claim was denied because the patient do not have benefits for inpatient medical treatment. So then you said y'all did the same to a uh appeal in our office for for this particular claim, is that what you're saying?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes. When it, when it was received it, could I get the received date?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Can, OK, the claim number that you just gave me, let me give it to you. We received this claim on 104. It was processed on 10/7.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] One moment. Process done.
[CUSTOMER][NEUTRAL] 107. OK.
[AGENT][NEGATIVE] Mhm. And it was denied.
[CUSTOMER][NEUTRAL] Yes, what is
[AGENT][NEUTRAL] Letting you know that the benefits that y'all, the, the medical treatment that was performed is not covered on this patient policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, can you repeat once again why it was denied?
[AGENT][NEUTRAL] The medical treatment that was done is not a payable benefit on the patient policy. She do not have, he do not have inpatient physician medical care.
[CUSTOMER][NEUTRAL] You do not have inpatient.
[AGENT][NEUTRAL] Position
[AGENT][NEUTRAL] Medical care.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Medical care. OK.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That was the denial reason. Could I request the UB?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I can put I can request the EOB to be put back in the mail. Yes, I can.
[CUSTOMER][NEUTRAL] We need
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. And could I get, yes.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK. I, what, what, what, what else do you need? Yeah, [PII]?
[CUSTOMER][NEUTRAL] True facts, through fax.
[AGENT][NEUTRAL] Oh, you want a fax you want our fax number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'll fax.
[CUSTOMER][NEUTRAL] Yes, 610
[AGENT][NEUTRAL] Oh, you want a fax number or you trying to give me a fax number?
[CUSTOMER][NEUTRAL] OK. 610.
[CUSTOMER][NEUTRAL] 834.
[AGENT][NEUTRAL] OK, [PII], I'm going to request that EOB to be put back in the mail to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that's what I'm gonna do. I'm gonna request it and if you wanna send something to our office and I can appeal, I can give you our fax number.
[CUSTOMER][NEUTRAL] OK. And could I get the claim number?
[AGENT][NEUTRAL] The claim number you just gave me the claim number, the claim number that we have is the one that you gave us.
[CUSTOMER][NEUTRAL] OK, got the call reference number?
[AGENT][NEUTRAL] 35
[AGENT][NEUTRAL] My name, [PII], and today's date.
[CUSTOMER][NEUTRAL] Tested [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh. Anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] OK. Yes.
[AGENT][NEUTRAL] [PII], can you hear me?
[CUSTOMER][NEUTRAL] Yes, I can hear you.
[AGENT][POSITIVE] OK, how can I help you? How else can I help you today?
[CUSTOMER][NEUTRAL] Yes, that's it.
[AGENT][NEUTRAL] Oh, does it just
[CUSTOMER][NEUTRAL] Could I, could I get the fax number?
[AGENT][NEUTRAL] Uh-huh, I'll fax the number [PII] for to do an appeal. If you're doing an appeal, put attention appeal department and that number that you can fax it to is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much, [PII], and have a great day. Bye-bye. Take care.
[AGENT][POSITIVE] All right. Thank you, [PII], for calling American Public Life. You have a wonderful day. Bye-bye.