AccountId: 011433970860
ContactId: 701f04db-eaf3-4242-822b-d99f39fb0dc9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 640739 ms
Total Talk Time (AGENT): 202426 ms
Total Talk Time (CUSTOMER): 162609 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/701f04db-eaf3-4242-822b-d99f39fb0dc9_20250203T20:02_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. So, my name is [PII]. Last name initial is [PII] and I'm calling from the provider's office. Can you help me with the claim status?
[AGENT][NEUTRAL] Yeah, sure. I can assist you with claim status, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, the callback number is [PII] with the [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and may I have the patient's policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yes. Patient's policy number is 02496908.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] And details for this is [PII].
[AGENT][NEUTRAL] OK. How much is the total charge?
[CUSTOMER][NEUTRAL] The total charge amount, just give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Charge amount is $685.88.
[AGENT][NEUTRAL] Thank you. Let me see if I can find this claim and for future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, let me look at this claim. One moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, here it is. All right, we processed this claim on [PII].
[AGENT][NEUTRAL] And we send a benefit amount of $614.37 to the provider.
[CUSTOMER][NEUTRAL] So you mean the claim is paid, right?
[AGENT][NEUTRAL] Yes, this claim is paid. The only code that didn't pay was 87038 because it's a non-cover procedure or non-cover item, but the rest is cover.
[CUSTOMER][NEUTRAL] OK. So, but uh we have submitted an appeal also on
[CUSTOMER][NEUTRAL] appeal was submitted on.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Sorry, [PII].
[CUSTOMER][NEUTRAL] Via mailing address.
[AGENT][NEUTRAL] OK, let me look at the appeal. One moment.
[CUSTOMER][NEUTRAL] Sorry, appeal was submitted on [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEGATIVE] And the appeal was um received on January and processed in January, and it was determined that upon review of the claim, we have found that the process of the policy of the claim was processed under the policy contract benefits are not payable for this service, so the, it's still denied.
[CUSTOMER][NEUTRAL] OK. So, may I know the exact date when you received the appeal and when it got upheld?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright
[AGENT][NEUTRAL] Yeah, one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] It was received [PII], processed [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I have the DCNN or the image number of the, of you, sure.
[AGENT][NEUTRAL] Um, the, it's gonna be under a claim number. The claim number is 3553332.
[CUSTOMER][NEUTRAL] OK. Can I have the call reference number also?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] And may I know your name, please?
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] OK. OK. So I have one more claim. Can you help me with that also?
[AGENT][NEUTRAL] OK, bear with me just a second. Let me make a note on this one. Do you need any other information on this one?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] One moment, let me do a note.
[CUSTOMER][NEUTRAL] have
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I think my.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] Yes, the next policy number is 02100309ML8.
[AGENT][NEUTRAL] What's the name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, can you repeat that number one more time, the policy number?
[CUSTOMER][NEUTRAL] Policy number is 02100309ML8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Data service is [PII] and the bill amount is
[CUSTOMER][NEUTRAL] $561.69.
[AGENT][NEUTRAL] $561.59.
[CUSTOMER][NEUTRAL] 561.69, yeah.
[AGENT][NEUTRAL] 69. OK, thank you.
[AGENT][NEUTRAL] All right, let me see if I have it right.
[AGENT][NEUTRAL] All right, it looks like we have processed the claim on [PII], and we send a benefit amount of $472.88. And again, the same code as the one prior did not pay, which is the 87038.
[CUSTOMER][NEUTRAL] OK, but we have submitted the, some documents which we have requested from the NOB.
[CUSTOMER][NEUTRAL] Uh, so, we have submitted the EOB on [PII].
[CUSTOMER][NEUTRAL] So, may I know
[AGENT][NEUTRAL] this is the process of that 1 [PII] we processed the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm, so we process and pay.
[CUSTOMER][NEUTRAL] So, can we sir
[AGENT][NEUTRAL] We just didn't pay that cold.
[CUSTOMER][NEUTRAL] So can we submit appeal for this one?
[AGENT][NEUTRAL] You can. You have 180 days from the decision date to submit the appeal.
[CUSTOMER][NEUTRAL] OK. Can I have the fax number to come?
[AGENT][NEGATIVE] But it was denied previously.
[AGENT][NEUTRAL] OK. Yes, it's 1877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][POSITIVE] OK, thank you so much. Can I have the call reference number?
[CUSTOMER][NEUTRAL] OK. Calls will be your name or.
[AGENT][NEUTRAL] We don't have reference correct.
[CUSTOMER][POSITIVE] Thank you so much. Can I have the claim number?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes, that is 354-5075.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome. You as well. Thank you for calling APL. Goodbye.