AccountId: 011433970860
ContactId: 5cb1bfef-32ee-428b-8ca5-5996e9ec171d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 363850 ms
Total Talk Time (AGENT): 135574 ms
Total Talk Time (CUSTOMER): 122337 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/5cb1bfef-32ee-428b-8ca5-5996e9ec171d_20250428T21:25_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Pediatrics Medical Group to claim status.
[AGENT][POSITIVE] OK, I'll be more than happy to assist you with the claim status and from my notes, can you spell your first name for me please and provide a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK. First name will be [PII] and last name initial be [PII]. And callback number will be [PII]. And could you spell your name for me?
[AGENT][NEUTRAL] Yes, my name is [PII]
[CUSTOMER][POSITIVE] Great. Thank you, [PII].
[AGENT][NEUTRAL] You're welcome. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] OK. So 1426647 ML 8.
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Yeah, just one claim.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII]. Date of birth will be [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim you like me to look at?
[CUSTOMER][NEUTRAL] OK. It's [PII] and bill amount will be $740 even.
[AGENT][NEUTRAL] So [PII] $740?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and $740 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And are you calling in reference to the original claim or the resubmitted claim?
[CUSTOMER][NEUTRAL] Yeah, it's uh one moment.
[CUSTOMER][NEUTRAL] Yeah, it's original claim.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's a pediatrics Medical Group.
[AGENT][NEUTRAL] Alright, so we received the claim. Let me make sure this is 286. OK, we received the claim originally on [PII].
[AGENT][NEUTRAL] That claim number is 344-9125.
[AGENT][NEUTRAL] And on [PII], the claim was denied as office visits are not covered by this um policy.
[CUSTOMER][NEUTRAL] OK. Dinner is not covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. We have sent an appeal on [PII]. Could you get the status of that?
[AGENT][NEUTRAL] Right, it was denied as a duplicate. Office visits are not covered on this policy. So unless the place of service changes, it's not covered by this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK. Previously, we sent an appeal. You said that uh it's appeal not on file and we don't have any timely filing limit for this to appeal. OK, as of now, we haven't received any UB.
[AGENT][NEUTRAL] So are you needing that
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Are you needing the appeals like when it was received and denied?
[CUSTOMER][NEUTRAL] No, no. It has been uh sent on [PII] and previously informed that uh I see here it's appeal on file and we don't have appeal timely fi limit for further appeal.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For adjustment, we need UB but we still, we haven't received any UB from your side.
[AGENT][NEUTRAL] So you're requesting an explanation of benefits from the original claim or the duplicate?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, it's forward you know claim.
[AGENT][NEUTRAL] OK, what's a good fax number for me to send the um explanation of benefits to?
[CUSTOMER][NEUTRAL] Yeah, one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. It's uh [PII].
[CUSTOMER][NEUTRAL] 333-3543.
[AGENT][NEUTRAL] And that's attention, A like apple.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Attention will be [PII].
[AGENT][NEUTRAL] Your name is [PII]? OK, that's why I asked you to spell it. I can't hear you in the beginning. OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's um fax number [PII], attention, [PII].
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] Alright, so I'll go ahead and fax this over to you now. And [PII], was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] No. How many minutes it will take to receive the fax? How many times?
[AGENT][POSITIVE] Uh, we say to give a fax at least an hour just in general. If you haven't received it by your end of day today, just give us a call and we'll be more than happy to resend it for you.
[CUSTOMER][NEUTRAL] OK. Thank you. Can I get the conference number, please?
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] There's no call reference number, but you can use my name and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for assisting me today. Have a great day.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No. Thank you for asking me.
[AGENT][POSITIVE] You're welcome. Thanks for calling APLC. I hope you have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm bye bye.