AccountId: 011433970860
ContactId: 758ec55f-20c8-48e8-b708-01d6b372ff0d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 963659 ms
Total Talk Time (AGENT): 157356 ms
Total Talk Time (CUSTOMER): 388527 ms
Interruptions: 13
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/758ec55f-20c8-48e8-b708-01d6b372ff0d_20250602T14:28_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. I'm calling from provider's office to check the claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you. And your name is again?
[CUSTOMER][NEUTRAL] [PII]. My initial name is [PII]. Can you spell your name?
[AGENT][NEUTRAL] Sure, [PII] last initial [PII] And what is the policy number, please?
[CUSTOMER][NEUTRAL] OK. The policy number is 1 minute, yeah. It's 01545808 M as in Mike, L as in Lima 8.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] It's, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] The patient first name is [PII] and the last name initial name of this member is [PII]. And the date of birth of this member is [PII]. And can I tell the date of service for the claim?
[AGENT][NEUTRAL] No, because I have to locate the patient first. That policy number you gave doesn't have that patient's name. So you said his name is [PII]. What was the last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You did
[CUSTOMER][NEUTRAL] I it is it.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, the correct policy number is 1548508.
[CUSTOMER][POSITIVE] It's right.
[AGENT][NEUTRAL] And you say you're calling for a claim status, correct?
[AGENT][NEUTRAL] OK, and now what is the data service and amount of the charge?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the bill amount of this claim is 155350.09 cents.
[AGENT][NEUTRAL] OK. And what is the balance after primary insurance has processed the claim?
[CUSTOMER][NEUTRAL] Uh, hold on, I'm checking in my system. Uh, this much, this much is in my system that is not showing the how much the amount is paid or not available. It's 155350.09 cents. Only this is showing in my system.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, give me one moment please.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I'm showing the claim processes services performed at a dialysis facilities are not covered under the policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] not covered another policy, right? The, what is the denial reason?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] dialysis facility is not covered for the patient's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] not covered on the not covered as the.
[AGENT][NEUTRAL] Per the patient's policy.
[CUSTOMER][NEUTRAL] Patient policy. And one minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I I.
[CUSTOMER][NEUTRAL] Uh, Kiki. Hello?
[AGENT][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] Can I place the call on hold for hardly one minute? If you OK that? Only one minute.
[AGENT][NEUTRAL] Oh, that's fine.
[CUSTOMER][NEUTRAL] Hello, hello, are you there?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hello, uh, how was the claim is, is outpatient or inpatient?
[CUSTOMER][NEUTRAL] you can
[AGENT][NEUTRAL] And this process is inpatient or outpatient.
[CUSTOMER][NEUTRAL] OK. Outpatient.
[CUSTOMER][NEUTRAL] Right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Can, can you reprocess this claim?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] You can submit if you don't agree with the claim decision you can submit an appeal to be reviewed. You have up to 180 days from the time the claim was processed to submit an appeal, and you must submit a letter stating the reason for the appeal.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Can it requires authorization?
[AGENT][NEUTRAL] I'm sorry. Say again.
[CUSTOMER][NEUTRAL] What is, what is the time frame for the authorization?
[AGENT][NEUTRAL] There is no authorization required, but if you want to submit an appeal because you do not agree with the claim decision, you have up to 180 days from the time the claim was processed to submit an appeal.
[CUSTOMER][NEUTRAL] Hello. Uh, one minute, I'm checking in my system that the claim, uh, the previous date of service has been paid for the patient.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what is that claim number?
[CUSTOMER][NEUTRAL] 01 minute.
[CUSTOMER][NEUTRAL] The claim number is not in my checking in my system.
[CUSTOMER][NEUTRAL] Yeah, the claim number is Q as in quick 1000.
[CUSTOMER][NEUTRAL] 45 conservative 01188921601.
[AGENT][NEUTRAL] Well, that's not our claim number.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] In my system that is only showing this, this only.
[AGENT][NEUTRAL] Well, it's not one of our claim numbers, so.
[AGENT][NEUTRAL] This claim processed correctly.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Oh, can I place your call on hold for hardly one minute, for one minute only? OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Hello, are you, are you there? Sorry for the delay. Sorry for the delay, and uh I am talking with my supervisor about this claim. Sorry for the inconvenience for, from my side. And uh what uh which date the patient does not, does not cover the dialysis plan?
[AGENT][NEUTRAL] I am here. Mhm.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm so[PII], say again.
[CUSTOMER][NEUTRAL] Uh, which date, uh, which of the date the dialysis patient not covered the dialysis plan?
[AGENT][NEGATIVE] I'm not understanding what you're asking.
[AGENT][NEUTRAL] You're talking about on the claim that was submitted, what date that they denied is not covered?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh, no, no, no. Uh, how, uh, which date of service the patient does not cover the dialysis plan?
[AGENT][NEUTRAL] Sir, you inquired about data service [PII], correct? The [PII]?
[AGENT][NEUTRAL] The whole claim process as services performed in a dialysis facility is not covered.
[CUSTOMER][POSITIVE] It's right. Uh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So I'm not understanding what you're asking. Please rephrase it.
[CUSTOMER][NEUTRAL] Uh no, uh, uh, OK. Uh.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah, sure. One minute.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, uh, can you tell me the, what is the denial date?
[AGENT][NEUTRAL] The claim processed on [PII] of this year.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] And what is the denial date? Uh, it's [PII], right? And uh this is not paid, right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Correct, it is not, is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, OK, thank you so much for giving me this information, uh, [PII], and what is the call reference for this one?
[AGENT][NEUTRAL] Uh, if you like, you may use my name with today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much for giving me this information and bye. Take care. Have a nice day and thank you so much for giving me this information. Bye.
[AGENT][NEUTRAL] You too.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL.