AccountId: 011433970860
ContactId: 5a0d2221-bb4c-4b24-97e0-2394c4777b3a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 392959 ms
Total Talk Time (AGENT): 164622 ms
Total Talk Time (CUSTOMER): 95282 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/5a0d2221-bb4c-4b24-97e0-2394c4777b3a_20250313T19:50_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII]. I'm calling from provider office for claims.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status. Is that correct?
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][POSITIVE] Yes, I can help you with that, [PII]. What is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And [PII], how many claims do you have to check status on today?
[CUSTOMER][NEUTRAL] Two claims for the same patient.
[AGENT][NEUTRAL] But they say
[AGENT][NEUTRAL] OK, yes, I can help you with that, [PII], and you will use my name that I gave you along with today's date as your call reference number.
[AGENT][NEUTRAL] And also any information that I provide for you on the claims will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh huh
[AGENT][NEUTRAL] And lastly, if we do have the claims on file, [PII], and you need a copy of the explanation of benefits, you may print those by going to our portal which is located at [PII].
[AGENT][NEUTRAL] And what is your patient's policy number, please?
[CUSTOMER][NEUTRAL] OK, so patient policy number is
[CUSTOMER][NEUTRAL] 02458531 M as in Mary, L 8.
[AGENT][POSITIVE] OK, thank you one moment please.
[AGENT][NEUTRAL] And your patient's name and their date of birth.
[CUSTOMER][NEUTRAL] Patient is.
[CUSTOMER][NEUTRAL] Patient is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And what is the first date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] Uh, [PII] and bill amount is $85.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this claim was received.
[AGENT][NEUTRAL] The received date will be one moment. I'll provide you that information. The received date was [PII].
[AGENT][NEUTRAL] And it was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 355-71777.
[AGENT][NEUTRAL] And the reason for the denial on this claim?
[AGENT][NEUTRAL] It's going to be
[AGENT][NEUTRAL] Kinesiology, speech, or occupational therapy are not covered benefits under this policy.
[CUSTOMER][NEUTRAL] Not covered, OK.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And this.
[CUSTOMER][NEUTRAL] So this is the patient responsibility.
[AGENT][NEUTRAL] We do not determine patient responsibility, [PII] because we are not a primary major medical insurance.
[AGENT][NEUTRAL] So the patient responsibility would be determined by the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, just a moment.
[CUSTOMER][NEUTRAL] And the next date of service for the same patient.
[AGENT][NEUTRAL] OK. Yes, ma'am.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] The service is
[CUSTOMER][NEUTRAL] [PII]. Bill amount is $85.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And you said it was [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, this claim was received also on [PII] and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3557043.
[AGENT][NEGATIVE] And it was denied for the same reason.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, so thank you so much for uh this information. If provider is the secretary can be submit anything like reconstitution appeal.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] An appeal must be filed within 180 days from the date of the decision, and it must be sent to Attention Appeals department.
[CUSTOMER][NEUTRAL] Appeals department and uh do you have fax number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]. Again attention appeals department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. Bye-bye. Have a nice day.
[AGENT][POSITIVE] You are very welcome. And again, is there anything else that I can help you with, [PII]?
[CUSTOMER][NEUTRAL] Uh, no, that's all.
[AGENT][POSITIVE] OK. Well then, thank you for calling APL and I hope you have a nice rest of your day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, you too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.