AccountId: 011433970860
ContactId: 5ce8deca-9a2a-41d4-a282-c161f8168859
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 859710 ms
Total Talk Time (AGENT): 274433 ms
Total Talk Time (CUSTOMER): 235855 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/5ce8deca-9a2a-41d4-a282-c161f8168859_20250416T13:18_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 from Pro office. So just I want to discuss about the claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status today. Do you have the policy number on you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, I have it me.
[CUSTOMER][NEUTRAL] Would you like to know?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] OK, so the policy number is going to be 01639192 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] Perfect, thank you.
[CUSTOMER][NEUTRAL] Welcome.
[AGENT][NEUTRAL] OK and then what's a good call back number in case our call gets dropped?
[CUSTOMER][NEUTRAL] Uh, that would be [PII].
[CUSTOMER][NEUTRAL] [PII] it's a direct line.
[AGENT][NEUTRAL] OK, perfect. Thank you. OK, and then patient's first name and last name and date of birth, please?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] My first name is going to be.
[CUSTOMER][NEUTRAL] [PII], her last name is [PII] and date of birth is on.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then do you have a data service and charge amount?
[CUSTOMER][NEUTRAL] Yes, I do have that. That would be 219 of 2025, uh, B is 7, is just one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The amount is going to be.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] $909 even.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] If you don't mind, could you please spell out your name?
[AGENT][NEUTRAL] My name?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Yes, it is [PII]
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[AGENT][POSITIVE] Yeah, you're welcome.
[AGENT][NEUTRAL] Sorry, just one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I am not seeing the charge amount of $909. Is there a different charge amount by chance?
[CUSTOMER][NEUTRAL] Let me check. Give me just one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So just I gave you the original bill. So initially which we have submitted uh to the primary, but the secondary charge amount is going to be $4 even uh.
[CUSTOMER][NEUTRAL] I think so, correct, $496.
[AGENT][NEUTRAL] You said 4000?
[CUSTOMER][NEUTRAL] Right? For $96.
[AGENT][NEUTRAL] 0, 496. OK.
[CUSTOMER][NEUTRAL] No, $496.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I do see that one, just a second, uh.
[CUSTOMER][NEUTRAL] Yeah, please.
[AGENT][NEUTRAL] And then the provider's office you're calling from?
[CUSTOMER][NEUTRAL] Yes, I'm calling from the flight.
[CUSTOMER][NEUTRAL] Sorry, Florida Women Care LLC.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, so for the amount 496.
[AGENT][NEUTRAL] I do have the claim number for that one if you'd like it.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It is 358.
[CUSTOMER][NEUTRAL] Please
[AGENT][NEUTRAL] 0490.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] When this claim and what is the process date?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like the received date was [PII].
[AGENT][NEUTRAL] And the process date was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And it looks like this one was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, it says the service is not covered when performed in a doctor's office or clinic is why the 496 was denied.
[CUSTOMER][NEUTRAL] It should be
[CUSTOMER][NEUTRAL] Covered in hospital.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah, it says the service is not covered when performed in a doctor's office or clinic.
[AGENT][NEUTRAL] Under this policy.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Under this policy based on this policy, right? OK, uh, place of service we had used, uh, 111, right.
[AGENT][NEUTRAL] Yes, yes, sir.
[CUSTOMER][NEUTRAL] And the claim form, can you able to see that?
[AGENT][NEUTRAL] So for claim 358-0490 in the amount of 496.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It just states the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Based on the contract, right?
[AGENT][NEUTRAL] Yes, based on this patient's policy.
[CUSTOMER][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] So this cic.
[CUSTOMER][NEUTRAL] Based on the patient policy.
[CUSTOMER][NEUTRAL] So just I wanted to confirm what is the planting.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So, the patient has a Medlink policy. It's Medlik SFM.
[CUSTOMER][NEUTRAL] Meddling like M E D L I N K.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yes, sir. M E D L I N K.
[AGENT][NEUTRAL] SFM.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And also, do you have any, uh, policy based on this non-covered?
[CUSTOMER][NEUTRAL] Any specific policy do you have with you?
[CUSTOMER][NEUTRAL] Contact policy or any article number.
[AGENT][NEUTRAL] Um, it says plan 3000 on it.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What is that? What is it?
[AGENT][NEUTRAL] It's plan 3000.
[CUSTOMER][NEUTRAL] Plant 3000 only.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] So, as I like, um, you follow medical guidelines or medical guidelines?
[AGENT][NEUTRAL] Sorry, what was that? Can you slow down just a little bit?
[CUSTOMER][NEUTRAL] Yeah, you follow Medicare guidelines or Medicaid guidelines, or else you have any, uh, specific.
[CUSTOMER][NEUTRAL] Guidelines American public insurance.
[AGENT][NEUTRAL] So.
[CUSTOMER][NEUTRAL] You follow own guidelines, right?
[AGENT][NEUTRAL] So Medlink is a secondary policy. So Medlik follows the major medical plan. So if the major medical plan does not cover anything, Medlink will not.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So you can just put that med link.
[AGENT][NEUTRAL] It's a secondary policy that follows the major medical plan.
[CUSTOMER][NEUTRAL] OK, you follow major medical plans guidelines, right?
[AGENT][NEUTRAL] No, not the major medical. We don't follow their guidelines. Medlink is.
[AGENT][NEUTRAL] Follows their own guidelines. It just depends on each patient's policy.
[CUSTOMER][POSITIVE] Correct
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] So we can build the balance to patient.
[AGENT][NEUTRAL] Sorry, what did you say?
[CUSTOMER][POSITIVE] We can build the balance to patient.
[AGENT][NEUTRAL] We do not determine patients responsibility.
[CUSTOMER][NEUTRAL] OK, or else, uh, how this claim was repro like how this claim is reprocessed and processed all the payments, uh, we have any other source like, uh, we can fill in a bill or we can send a corrected claim.
[AGENT][NEUTRAL] So there's no there's no filing limit to submit a claim with APL.
[CUSTOMER][NEUTRAL] And the changes are.
[CUSTOMER][NEUTRAL] OK. Uh, can I get the mailing address and correct mailing address?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, you want the claim address?
[CUSTOMER][NEUTRAL] Yeah, appeal mailing address and also claim mailing address.
[AGENT][NEUTRAL] Yes, so the claim mailing address is [PII].
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what I mailing address.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] So that is our mailing address.
[CUSTOMER][NEUTRAL] For both, right, appeals and as well corrected claim.
[AGENT][NEUTRAL] Yes, for claims. And then if you need our fax number, I also have that.
[CUSTOMER][NEUTRAL] Please go ahead.
[AGENT][NEUTRAL] Do you need our fax number as well?
[CUSTOMER][NEUTRAL] Yes, for appeals, right?
[AGENT][NEUTRAL] Fax, yes, it is.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 [PII].
[CUSTOMER][NEUTRAL] Attention to.
[AGENT][NEUTRAL] Uh, you can just put APL.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] AP OK.
[AGENT][NEUTRAL] Along with the policy number, please.
[CUSTOMER][NEUTRAL] Which policy number?
[AGENT][NEUTRAL] It would be 163 9.
[AGENT][NEUTRAL] 192.
[CUSTOMER][NEUTRAL] OK, let me reconfirm that.
[CUSTOMER][NEUTRAL] Uh, you give me the mailing address for both appeals as well currently claim that would be [PII].
[CUSTOMER][NEUTRAL] [PII] and the fax number is [PII] attention to APL.
[AGENT][POSITIVE] Yes, that is correct. Mhm.
[CUSTOMER][NEUTRAL] Um, what is the time you're filling limit for appeals?
[AGENT][NEUTRAL] There is no filing limit.
[CUSTOMER][NEUTRAL] For appeals
[AGENT][NEUTRAL] So there's no filing limit to submit a claim.
[CUSTOMER][NEUTRAL] OK, so there is no time you're filing for, uh, appeals as credited claim both right.
[AGENT][NEUTRAL] Yes, no filing limit to submit a claim.
[AGENT][NEUTRAL] Did you have any further questions for this policy?
[CUSTOMER][NEUTRAL] Uh, yes, uh, oh, so what is the appeal timely filing?
[AGENT][NEUTRAL] There's no filing limit to submit a claim?
[CUSTOMER][NEUTRAL] OK, uh, what is the call reference number?
[AGENT][NEUTRAL] The call reference number would be my first name, which is [PII]
[AGENT][NEUTRAL] And my last initial [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then today's date.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Of course you're welcome. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] That's all now. Thank you so much.
[AGENT][POSITIVE] All right, yep, thanks for calling APL. I hope you have a great day, [PII].
[CUSTOMER][POSITIVE] You too take care bye bye and stay safe. Bye bye.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, bye.