AccountId: 011433970860
ContactId: 5f481888-1d2f-4e66-80de-2a960d015618
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 283920 ms
Total Talk Time (AGENT): 99711 ms
Total Talk Time (CUSTOMER): 128032 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/5f481888-1d2f-4e66-80de-2a960d015618_20250109T14:53_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, could you please spell your name for me?
[AGENT][NEUTRAL] Sure, that's [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Hi, So. This is [PII], and I'm calling for Augusta Medical Group to check on additional information about the claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes. I've already checked you'll be I need additional information on denied claims. So could you please help me with that?
[AGENT][NEUTRAL] Sure, I can assist you with claim information. And may I have the spelling of your name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you, Ms. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, the callback number would be [PII], no extension.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The members
[CUSTOMER][NEUTRAL] ID number is 02282209.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes. The first name is [PII] and the last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, perfect, thank you. And may I have uh either the claim number or the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total bill amount is $138 even.
[AGENT][NEUTRAL] OK, thank you. Let me check and see if I can find this claim for you. And for future, you can check claim status online through our website at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK. Thank you for that information, So.
[AGENT][NEUTRAL] You're welcome. OK, one moment, let's see.
[AGENT][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, it looks like we received a claim [PII], processed the claim [PII], and the claim was denied stating that office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh the offices are not covered by the policy. So it's as per patients plan or uh provider's contract.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Under the member's plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] According to member's plan. OK. Just a moment. I'm just noting it down.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, may I have the correct claim filing limit for this?
[AGENT][NEUTRAL] We don't have a correct claim filing limit. We have an appeal which is 180 days from the decision day for any appeal decisions, but um we don't have a corrected claim.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK. So 180 days from date of the Nile, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] And uh just wanted to confirm the mailing address. Just a moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Is it [PII]?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][POSITIVE] OK. OK. So thank you so much. May I have your call reference number for this?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sure. Thank you so much for helping me with this case. So today.
[AGENT][NEUTRAL] Mhm. Or anything?
[AGENT][POSITIVE] Mhm. You're welcome.
[CUSTOMER][NEUTRAL] That's all the information I needed.
[AGENT][POSITIVE] Thank you, thank you for calling APL. You have a good day. Bye-bye, Miss.
[CUSTOMER][POSITIVE] You too have a great day. Take care. Bye-bye.
[AGENT][NEUTRAL] Mhm.