AccountId: 011433970860
ContactId: 6de7d168-698a-48db-a632-9fcd17f1d5e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1359079 ms
Total Talk Time (AGENT): 263723 ms
Total Talk Time (CUSTOMER): 244453 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/6de7d168-698a-48db-a632-9fcd17f1d5e6_20250401T20:30_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Uh, this is [PII] and I'm calling for the provider, [PII] Massively to check on our status. Please be informed this call has been recorded and monitored for training and quality purposes. May I know if I can help with the patient's information or the provider's information?
[AGENT][NEUTRAL] Yes, let me have the name of the provider and a callback number just in case we get disconnected, Mr. [PII].
[CUSTOMER][NEUTRAL] Provider's name is [PII], and the callback number is [PII]. It's a direct line extension.
[AGENT][NEUTRAL] OK, thank you. And what is the patient's policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Member ID is 022.
[CUSTOMER][NEUTRAL] 10891.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK thank you one moment. I put that information.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK. Thank you, Mr. [PII], and you need claim status or eligibility?
[CUSTOMER][NEUTRAL] I'm looking for an appeal status.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] And see what is the date of service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] How much is it to charge?
[CUSTOMER][NEUTRAL] 49. 1 moment, OK?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's $276 even 276.
[AGENT][NEUTRAL] Oh, OK, let me check and see if I find an appeal. Do you mind holding for me?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding and being patient for Mr. [PII]. OK, um, I did not sign an appeal. I do, I do see where it was sent twice. Like the first time that it was sent in, uh, we went ahead and sent the payment and then we received it again. Yes. Hello?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] OK, so I did not sign an appeal. I got two submissions. One is the original one which we paid that $25 for 99213, and the other one is a denial as a duplicate.
[AGENT][NEGATIVE] But I don't see an appeal.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mr. [PII], can you hear me?
[AGENT][NEUTRAL] Mr. [PII], can you hear me?
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, Mr. [PII], can you hear me?
[CUSTOMER][NEUTRAL] Hello, can you hear me, Miss Miss [PII]?
[AGENT][NEUTRAL] Hello, Mr. I can hear you. Can you hear me?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Hello. You are on hold.
[AGENT][NEUTRAL] Hello, Mr. [PII], can you hear me?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Um, again, let me repeat again. Um, we have now received an appeal.
[AGENT][NEUTRAL] We have two submissions. The original one which we send the benefit of $25 and the duplicate submission. So those are the only two submissions that I have found for that date of service for that amount.
[CUSTOMER][NEUTRAL] So for which date it's the submission?
[AGENT][NEUTRAL] The date of service of [PII] for 276.
[CUSTOMER][NEUTRAL] You know, for which date the submission has been sent?
[CUSTOMER][NEUTRAL] The claim is submitted?
[AGENT][NEUTRAL] I'm sorry, what do you mean by that? So I understand what's your question.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And when was the claim submitted and which date you have?
[AGENT][NEUTRAL] Which days we received the claims? OK, let me tell you what days we received the claims. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] All right. So the original claim, which it was paid was received [PII], processed [PII].
[AGENT][NEUTRAL] And the duplicate submission was received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] All right, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the claim was in, the claim was submitted on [PII].
[AGENT][NEUTRAL] The original claim was received [PII]. That's when it was received.
[CUSTOMER][NEUTRAL] All right, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And you did not receive any appeal, right?
[AGENT][NEUTRAL] No appeals received.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right, thank you for the line. Hello.
[AGENT][POSITIVE] You're welcome. Yes.
[CUSTOMER][NEUTRAL] Yes, miss. One moment, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] All right and what is the correct address with attention to submit the appeal?
[AGENT][NEUTRAL] OK, um, the address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] All right. One moment. And what is with attention?
[AGENT][NEUTRAL] Appeals department.
[CUSTOMER][NEUTRAL] All right. And what is the time you're filing to submit the appeal?
[AGENT][NEUTRAL] 180 days from the decision date.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Is there any specific form that we need to use?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Do we need to address the DNADB?
[AGENT][NEUTRAL] Do we have to what I'm sorry?
[AGENT][NEUTRAL] What's your question?
[CUSTOMER][NEUTRAL] I'm sorry. Uh, do we need to attach the DUB?
[AGENT][NEUTRAL] No, you don't, because, um, well, we paid on this one, but yeah, you don't have to attach any of it to send an appeal.
[CUSTOMER][NEUTRAL] All right. And what is the timely falling to submit, what is the timely filing to for collected claim?
[AGENT][NEUTRAL] I correct the claim there's no timely filing limits.
[CUSTOMER][NEUTRAL] Alright, and the mailing address to submit a corrected claim is the same.
[AGENT][NEUTRAL] It's the same. Mhm.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right. Thank you for the line.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So I have uh one more claim to discuss.
[AGENT][NEUTRAL] Is it a different member or the same member?
[CUSTOMER][NEUTRAL] It's last.
[CUSTOMER][NEUTRAL] Different member.
[AGENT][NEUTRAL] Bear with me and you don't need any other information on this one?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, let me make a note, one moment.
[CUSTOMER][NEUTRAL] Bye
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That way
[AGENT][NEUTRAL] All right, what's the new policy number?
[CUSTOMER][NEUTRAL] So it's uh 1255.
[CUSTOMER][NEUTRAL] 3 consecutive zeros, M as in Mike, L as in Lima, the number 8.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It is service [PII].
[CUSTOMER][NEUTRAL] 2023
[CUSTOMER][NEUTRAL] And one moment, I will help you with the bill amount, OK?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right, it's $17 even, 17.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let me see if I can find it.
[AGENT][NEUTRAL] That was [PII].
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this one, let's see, looks like it was denied because service in office is not covered under this policy.
[AGENT][NEUTRAL] It was processed on let's see.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So it is denied as services in office is not covered under this policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right. One moment.
[CUSTOMER][NEUTRAL] And ma'am, uh, it's under the patient's policy or the provider's policy?
[AGENT][NEUTRAL] Patient's policy.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Thank you for the information.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is there anything else I can help you with today, Mister [PII]?
[CUSTOMER][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] So the the claim is denied on [PII], right?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] And when did you, uh, may I know the received date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And which CPT code is not covered as per patient's policy?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. The only one that was listed was 36415.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And what is the time you're falling to submit a corrected claim?
[AGENT][NEGATIVE] No timely founding limits.
[CUSTOMER][NEUTRAL] And the address is same as for the previous claim for appeal and the corrected claim.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And is there any specific form for appeal?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Uh, no dinner will be required, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right. One moment, OK?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, and I have the claim number as 353-2650. Is that correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Alright, could you help me with the call reference number for both the claims?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] Soul and Pradesh state, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] All right, Ms. [PII]. Thank you for your assistance. Have a nice day.
[AGENT][POSITIVE] You as well. Thank you for calling APL. Very good afternoon, Mr. [PII]. Bye-bye.