AccountId: 011433970860
ContactId: 60623d99-7bbf-4dd2-b697-92d4b76ce366
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 369779 ms
Total Talk Time (AGENT): 136753 ms
Total Talk Time (CUSTOMER): 109612 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/60623d99-7bbf-4dd2-b697-92d4b76ce366_20250325T21:13_UTC.wav
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[AGENT][NEUTRAL] Good afternoon thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling for a provider's office 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.
[CUSTOMER][NEUTRAL] And could you please spell out your name?
[AGENT][NEUTRAL] Sure, that's [PII]. That's initial is [PII], and you said your name is [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, it is [PII], [PII]
[AGENT][NEUTRAL] [PII]. OK. And may I have a callback number just in case we get disconnected with [PII]?
[CUSTOMER][NEUTRAL] Yeah, sure. It is [PII]. It's a direct line or extension.
[AGENT][NEUTRAL] And what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It does, uh,
[CUSTOMER][NEUTRAL] Cedar Springs Hospitalist.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] It is 60801.
[AGENT][NEUTRAL] That is the payer ID. Do you have the policy certificate number? If you're looking at the card, it's in the bottom where it says outpatient cert.
[CUSTOMER][NEUTRAL] Let me check that one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] You want the policy number, right? It is 024.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 65433.
[AGENT][NEUTRAL] OK. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The date of service is uh [PII] and the total charge amount.
[CUSTOMER][NEUTRAL] One moment, let me get that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is 1000.
[CUSTOMER][NEUTRAL] $929.91.
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And for the future, you can check claim status online through our website at [PII] and that's just optional, OK?
[AGENT][NEUTRAL] Um, and let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me pull this here. OK, one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, we processed the claim on [PII] and the claim was denied. The reason for this denial is, uh, let's see.
[AGENT][NEUTRAL] The benefits are payable only if major medical insurance provide benefits.
[AGENT][NEUTRAL] So we need the explanation of benefits showing that the amount was applied either towards the deductible, co-payment or co-insurance.
[CUSTOMER][NEUTRAL] OK. Since the primary did not pay this claim and you also didn't pay it, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you so much. And can I have the mailing address?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] And what is the time limit?
[AGENT][NEUTRAL] We don't have time following limits.
[CUSTOMER][NEUTRAL] And who's attention to?
[AGENT][NEUTRAL] Um, appeals department.
[CUSTOMER][NEUTRAL] And is there any specific form required to attach to that?
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] Thank you so much. And also, can I have the my mailing address?
[AGENT][NEUTRAL] It's the same address.
[CUSTOMER][NEUTRAL] And the time limit for the claim?
[AGENT][NEUTRAL] We don't have timely filing limits for corrected claims.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] OK. And uh attention to?
[AGENT][NEUTRAL] Claims department.
[CUSTOMER][NEUTRAL] And is there any specific form?
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] Thank you so much. Yes, and that's all for today. Can I have the call reference number, please?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's state if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][POSITIVE] No, thank you, thank you so much. It was a pleasure talking to you. And when did you receive this screen, sorry?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Um, I'll have to pull that up. One moment, one moment, that's not on the EB.
[CUSTOMER][NEUTRAL] When did you receive
[AGENT][NEUTRAL] Just a minute, let me search that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, OK, take your time.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] was received on [PII].
[CUSTOMER][POSITIVE] Thank you, thank you so much. It was a pleasure talking to you, and you have a wonderful rest of the day. Bye bye.
[AGENT][POSITIVE] You're welcome. You as well, Mr.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye.