AccountId: 011433970860
ContactId: 62d2263a-330b-4888-aee9-a7f1f5731dd0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 825460 ms
Total Talk Time (AGENT): 224079 ms
Total Talk Time (CUSTOMER): 155441 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/62d2263a-330b-4888-aee9-a7f1f5731dd0_20250407T18:38_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] [PII], this is [PII] from provider's office. Can you please assist me with the claim that?
[AGENT][POSITIVE] I'm happy to check on a claim for you. What's the patient's policy number?
[CUSTOMER][NEUTRAL] D as in Delta, and then number 45400896.
[AGENT][NEUTRAL] OK, unfortunately, sir, I can't pull the patient with that number. Do you have their name or social?
[CUSTOMER][NEUTRAL] Uh I'm having a name. It's [PII].
[CUSTOMER][NEUTRAL] And number pink name and then uh [PII]
[AGENT][NEUTRAL] So last name is [PII].
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much one moment.
[AGENT][NEUTRAL] What is the member's date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, and then may I please have the date of service?
[CUSTOMER][NEUTRAL] Yes, sure. Date of service for December.
[CUSTOMER][NEUTRAL] It's uh [PII] will amount $30.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] So it looks like we did receive a claim for the state of service on [PII]. Claim was denied [PII]. The reason for the denial was um the outpatient benefit only allows a payment for outpatient surgery in a hospital or physician office. Therefore, there were no benefits payable.
[CUSTOMER][NEUTRAL] With um
[CUSTOMER][NEUTRAL] You received the claim on [PII] and denied the claim on [PII] and reason is outpatient uh
[CUSTOMER][NEUTRAL] Can you please repeat that? I have to note it down.
[AGENT][NEUTRAL] Outpatient surgery, uh, payment is only permitted in an outpatient hospital or physician office.
[AGENT][NEGATIVE] Place of service was denied.
[CUSTOMER][NEUTRAL] Outpatient hospital or professional.
[AGENT][NEUTRAL] Outpatient hospitals.
[CUSTOMER][NEUTRAL] Uh, place of services then.
[CUSTOMER][NEGATIVE] So basically, place of service is denied.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Can you please text me you provide me the claim number?
[AGENT][NEUTRAL] Claim number is 3369965.
[CUSTOMER][NEUTRAL] OK. That's it.
[AGENT][NEUTRAL] Well, mhm, mhm. What's a good fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Just to confirm that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Should we mark attention to anybody?
[CUSTOMER][NEUTRAL] Uh, for the same
[CUSTOMER][NEUTRAL] Temple University.
[AGENT][NEUTRAL] OK, EOB is on its way. You should be there in about 5 minutes.
[CUSTOMER][NEUTRAL] For the
[CUSTOMER][NEUTRAL] For, for the same patient, there are 3 more data services.
[AGENT][NEUTRAL] OK, give me just one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, what's the next date of service?
[CUSTOMER][NEUTRAL] [PII], bill amount $30.
[AGENT][NEUTRAL] So we did receive a claim for the state of service claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, the claim was denied. It looks like, uh, diagnostic testing.
[AGENT][NEUTRAL] It says medical test for this state of service is not a covered diagnostic test, therefore, there were no benefits payable.
[CUSTOMER][NEUTRAL] OK. Uh, what is the claim number and denial date?
[AGENT][NEUTRAL] Claim number is 3361253.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Can you please explain?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Please explain you before this one as well.
[AGENT][POSITIVE] Yes, it's on its way.
[CUSTOMER][NEUTRAL] No, there is, uh, uh, are you ready for the next one?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] October, uh sorry, [PII] build amount $30.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yeah, just one moment please.
[AGENT][NEUTRAL] This claim was received on [PII].
[AGENT][NEUTRAL] A claim was denied. Uh, looks like the place of service, outpatient only allows for patient uh to be seen in an outpatient surgery, hospital, or physician's office.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Claim number and then I'll it.
[AGENT][NEUTRAL] Claim number is 3367591.
[AGENT][NEUTRAL] And the claim was denied [PII].
[CUSTOMER][NEUTRAL] Expanding.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The last date of service. Are you ready for the last one?
[AGENT][NEUTRAL] Uh, yes. What's the last date?
[CUSTOMER][NEUTRAL] [PII] bill amount $350.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] We did receive a claim, it looks like for the state of service claim was received on [PII].
[AGENT][NEUTRAL] Claim was denied on [PII]. Member was not active at the time of service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, what is the claim number?
[AGENT][NEUTRAL] Claim number is 3,523,310.
[CUSTOMER][NEUTRAL] Uh, do you have any information like which, uh,
[CUSTOMER][NEUTRAL] Um, insurance is active on the date of service.
[AGENT][NEUTRAL] No, we do not.
[CUSTOMER][NEUTRAL] Uh, please fax menu before this one, and can you please provide me the appeal mailing address and timely filing limit?
[AGENT][NEUTRAL] Appeal mailing address um is going to be
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII] City, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Intention to
[AGENT][NEUTRAL] Attention to appeals.
[CUSTOMER][NEUTRAL] And what is the timely filing limit?
[AGENT][NEUTRAL] For an appeal, it's 180 days from the decision date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, what is the call reference ID for this call?
[AGENT][NEUTRAL] Call reference is going to be my name with my last initials and today's date. My name is [PII], which is [PII] Last initial is gonna be [PII].
[CUSTOMER][POSITIVE] Thank you so much sir have a great day bye bye.
[AGENT][NEUTRAL] You too. Bye bye.