AccountId: 011433970860
ContactId: 6f46a8a2-6167-48a7-877f-343b502d1c42
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1198719 ms
Total Talk Time (AGENT): 234319 ms
Total Talk Time (CUSTOMER): 707419 ms
Interruptions: 13
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/6f46a8a2-6167-48a7-877f-343b502d1c42_20250327T15:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I didn't catch your name. Hello. Sorry, I didn't catch your name. Hello? Sorry, I didn't catch your name. [PII]. Hello, [PII]. This is [PII] calling for Provir Cardiovascular Medicine Associates to check on my claim status. Please be informed that this call is being recorded and monitored for quality and training purposes.
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Uh, my name is [PII].
[AGENT][NEUTRAL] OK, [PII], I can check claim status for you. Do you have a good callback number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, we do have a good callback number.
[CUSTOMER][NEUTRAL] Uh, good callback number is [PII]. My extension is a direct line.
[AGENT][NEUTRAL] Do you have the patient policy ID?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm yes, I do have. Uh, it's 021-63632 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the patient's name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] And what was that date of service?
[CUSTOMER][NEUTRAL] Um, data services.
[CUSTOMER][NEUTRAL] November, oh sorry, [PII].
[AGENT][NEUTRAL] And the bill charges?
[CUSTOMER][NEUTRAL] Yes, the charge amount is $424 even.
[AGENT][NEUTRAL] OK, let me look at that claim. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, it looks like the service is not covered when performed in a doctor's office.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, what?
[AGENT][NEUTRAL] The service is not a covered service in the doctor's office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So this claim is denied then?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the service is not covered under the doctor's office, is that correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Mm, OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] that's good.
[CUSTOMER][NEUTRAL] you know what you need.
[AGENT][NEUTRAL] Do you need the received date and process date?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yes. So, so as per provider contract, it's not covered, right?
[AGENT][NEUTRAL] Uh, it doesn't have anything to do with the provider contract. It's just under this policy, this is not a covered service in the doctor's office.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Fine. Uh, yes, could you please help me with the claim received date then?
[AGENT][NEUTRAL] Received date is [PII].
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Which specialities uh provider registered under?
[AGENT][NEUTRAL] Which what?
[CUSTOMER][NEUTRAL] Uh, which specialty is the doctor registered under?
[AGENT][NEUTRAL] Uh, we just have the doctor's name. This we don't utilize networks or anything, so.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So, what will be the doctor's name?
[AGENT][NEUTRAL] Well, do you have the doctor's name? You filed the claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Actually.
[CUSTOMER][NEUTRAL] I do not have that information because we are the third party so that I, that information I don't have. I'm sorry.
[AGENT][NEUTRAL] OK, yeah, I just have what you had stated previously, the cardiovascular medicine associate.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, kindly filing to submit and corrected claim would be.
[AGENT][NEUTRAL] Uh, there, it's, there's no limit.
[AGENT][NEUTRAL] You can file any time.
[CUSTOMER][NEUTRAL] No. That's fine. Thank you. And mailing address to submit and corrected claim.
[AGENT][NEUTRAL] Mailing address is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][POSITIVE] Thank you. And
[CUSTOMER][NEUTRAL] Yes, time filing to submit an appeal would be.
[AGENT][NEUTRAL] 180 days from process date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And yes, [PII], is there any specific appeal form is needed while submitting a claim or an appeal?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Is there any specific form needed to file an appeal or a corrected claim?
[AGENT][NEUTRAL] No, there's no specific form.
[AGENT][NEUTRAL] Just reference the claim number that you're filing it for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so just the claim number and uh nothing else, right?
[AGENT][NEUTRAL] Yes, that's correct. Uh, claim number is 340.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] 1494.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] 340-1494. OK, thank you. And yes, is denied, UOB is required while submitting a claim.
[AGENT][NEUTRAL] Um, you, you can just submit the, the claim number along with the appeal or.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] There's no need to submit an EOB, right? OK, thank you.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and yes, can I get the call reference for this number? And actually, I do have one more claim to review and it's for a different number.
[AGENT][NEUTRAL] Uh, the call reference number is my name, [PII]
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Last initial [PII] and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then did you say it was for the same patient or a different one?
[CUSTOMER][NEUTRAL] Um, yes, let me see once again. OK, so this is the different pa[PII].
[AGENT][NEUTRAL] OK, um, hold on one moment, let me make some notes real quick if you don't mind.
[CUSTOMER][NEUTRAL] Yes, sir, sure.
[AGENT][NEUTRAL] OK, [PII], what's that next policy number for a different patient?
[CUSTOMER][NEUTRAL] Mm, yes.
[CUSTOMER][NEUTRAL] Uh, the member ID is 0234.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, sorry. It's 02342158.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Do you have the patient name and date of birth?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Mm, yes. The patient name is [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what was that date of service?
[CUSTOMER][NEUTRAL] Oh yes, the date of service is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I was I was I I I.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let's see, I, this policy terminated [PII], but let me see if he has a different policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I don't have a claim on file and that's the only policy I had, which again terminated 6-18-2023.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So for the date of service, this patient was not eligible?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I place your call on a brief hold please? I'll be back within 13 seconds. Thank you.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, absolutely.
[CUSTOMER][POSITIVE] Uh, thank you for staying connected, [PII]. I really appreciate your patience.
[AGENT][POSITIVE] Yeah, no problem.
[CUSTOMER][NEUTRAL] So, is there any
[CUSTOMER][NEUTRAL] Is there any other insurance listed for this member?
[AGENT][NEUTRAL] Um, no, I don't show any other insurance.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] Um, yes, could you please help me with the claim receive date then?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, I don't have the claim on file.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Mm, so there is no denial also, right? OK. So could you please help me with the policy effective and the term date?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, that is.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Policy was effective 522-2023.
[CUSTOMER][NEUTRAL] 1 2nd.
[AGENT][NEUTRAL] Termination date was [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Mhm. OK, thank you.
[CUSTOMER][NEUTRAL] Um, so do you have information when was the last COB or coordination of benefit was updated?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] About
[CUSTOMER][NEUTRAL] Do you have information of when was the last COB was updated like coordination of benefits?
[AGENT][NEUTRAL] Like the last claim received or?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, yes, yes, like that.
[AGENT][NEUTRAL] Well, we would, we would only answer for claims that you're calling about for what for the provider, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm, so.
[AGENT][NEGATIVE] I don't have anything for the date of service that you referenced.
[CUSTOMER][NEUTRAL] OK, that's fine then.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] And there is no other payer listed for this number, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm. And timely filing to submit and corrected claim would be?
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, fine. There's no time to selling limit. OK. Mailing address would be the same one, the one which we discussed before.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] And yes, the timely filing to submit an appeal would be the same, 180 days.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] And there is no uh specific form is needed to file an appeal, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm. Just, uh, can you please help me with the claim number if you have?
[AGENT][NEUTRAL] We don't have the claim on file. There is no claim.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm that's fine.
[CUSTOMER][POSITIVE] And denied UB is not required by submitting a claim, right, uh, but actually there is no denial. I'm so sorry, right.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] Yes, uh, so, yes, could you please help me with the call reference number for this number?
[AGENT][NEUTRAL] Uh, it's the same as last. It's my first name, first name, last initial, and then today's date.
[CUSTOMER][NEUTRAL] Oh your name and
[CUSTOMER][POSITIVE] OK, thank you, thank you so much.
[AGENT][NEUTRAL] [PII], yeah.
[CUSTOMER][NEUTRAL] OK, definitely, and today is it. OK. So there was just one question I needed to ask about the claim which we discussed before, [PII], uh, actually,
[CUSTOMER][NEUTRAL] We have built a claim on [PII], and we have submitted some uh medical records with that. Have you received it?
[AGENT][NEUTRAL] OK, what are we going back to the other policy?
[CUSTOMER][NEUTRAL] Mm, yes, the one which we discussed before, the first one.
[AGENT][NEUTRAL] OK, um, let me get that pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And you said you submitted uh additional information or?
[CUSTOMER][NEUTRAL] Yes, with the medical reports.
[AGENT][NEUTRAL] OK. Do you have that policy number again, please?
[CUSTOMER][NEUTRAL] Yes, policy number, yes. Um it's 02163632.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, the number 8.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was that date of service again?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Date of service was.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said you submitted additional information on what date?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, on, uh, [PII] with some medical records.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Um, we receive, we received two duplicate claims, but it didn't have anything additional for us to process.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that the original denial is is stands, it's it's not a covered service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] Uh, the recent one was submitted was denied as duplicate, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] And there is some medical records you see on file?
[AGENT][NEGATIVE] It it's just not a covered service so the records submitted we it it's still denied.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, that's fine. But you have received and it got denied, right? On [PII], right? Mhm. Thank you. Thank you for the confirmation. And yes.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much for your valuable assistance, [PII]. You have a wonderful day ahead.
[AGENT][POSITIVE] OK, thank you, [PII], for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.