AccountId: 011433970860
ContactId: 6a84d9aa-8a83-410e-a76b-0603094dfd66
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 256160 ms
Total Talk Time (AGENT): 58065 ms
Total Talk Time (CUSTOMER): 107585 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/6a84d9aa-8a83-410e-a76b-0603094dfd66_20250506T20:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling for the provider to check on a claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. So may I know how can I help you with the patient's information or the provider's information?
[AGENT][NEUTRAL] I need a good callback number, [PII], and then I can help with claim status.
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. No no extension it's a direct line.
[AGENT][NEUTRAL] Policy number of the patient?
[CUSTOMER][NEUTRAL] Policy number will be 01731713 M as in Mike L as in Lima and the number 8.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and the last name is [PII]. The date of birth will be [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Date of service and bill charges.
[CUSTOMER][NEUTRAL] Date of service is [PII] and the bill charges will be $658 even.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I have a claim for 302.
[CUSTOMER][NEUTRAL] have
[AGENT][NEUTRAL] Have a claim for the dollar amount you gave me.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yeah, you're right. 302.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, looks like we received this.
[AGENT][NEUTRAL] 3 12 2025 process 3 17 2025.
[AGENT][NEGATIVE] And it was denied as not a covered service.
[CUSTOMER][NEUTRAL] And the member's panel provide this plan?
[AGENT][NEUTRAL] It's not covered under the member's plan, correct?
[CUSTOMER][NEUTRAL] OK, and claim number?
[AGENT][NEUTRAL] 3576528
[CUSTOMER][NEUTRAL] OK, just a moment, [PII].
[CUSTOMER][NEUTRAL] And could you please tell me which CPT code is not got under the member's plan?
[AGENT][NEUTRAL] 99213.
[CUSTOMER][NEUTRAL] Uh, sorry, your voice break. Could you please tell it once again?
[AGENT][NEUTRAL] 99213.
[CUSTOMER][NEUTRAL] OK. And uh timely fine to submit the collected claim?
[AGENT][NEGATIVE] Uh, there's no timely filing.
[AGENT][NEUTRAL] Let
[CUSTOMER][NEUTRAL] Mailing address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] 73124-8950
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And for the main appeals, there will be the same, no timely firing limit.
[AGENT][NEUTRAL] Uh, it's 180 days from the process date.
[CUSTOMER][NEUTRAL] And the address will be the same.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Is there any specific form for an appeal?
[AGENT][NEUTRAL] No, there's not.
[CUSTOMER][NEUTRAL] Do you require the ID while submitting the claim?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Reference number will be your name and the date.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thanks, [PII], for your assistance and have a great day. I just have one claim for the day.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a great day too. Bye-bye.