AccountId: 011433970860
ContactId: 76034e44-f1b1-4374-b058-66569adfc7f4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 299140 ms
Total Talk Time (AGENT): 142674 ms
Total Talk Time (CUSTOMER): 99690 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/76034e44-f1b1-4374-b058-66569adfc7f4_20250123T13:43_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] it.
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the doctor's office, looking for the claim denial clarifications.
[AGENT][POSITIVE] [PII], it would be my pleasure to help you with that claim denial. What is a good callback number?
[CUSTOMER][POSITIVE] It would be my pleasure to help you with that.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And do you happen to have the claim number?
[CUSTOMER][POSITIVE] Thank you, [PII], and do you
[CUSTOMER][NEUTRAL] Yes, uh, the claim number is, it's uh 353-5841.
[AGENT][NEUTRAL] And what is the patient's name and date of birth please, sir?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You see, the patient name is, it's uh [PII] and the date of birth is, it's a moment.
[CUSTOMER][NEUTRAL] So it's uh [PII].
[AGENT][POSITIVE] Alright, thank you, and it would be my pleasure to assist you with this claim denial.
[AGENT][NEUTRAL] And what was the data service and provider name please?
[CUSTOMER][NEUTRAL] Yes, so the date of service is it [PII], and I'm calling from the Advanced pain management.
[AGENT][NEUTRAL] All right, thank you. Now tell me, this claim we did receive on [PII] and denied on [PII].
[AGENT][NEUTRAL] And this claim was denied because the services are not covered when performed in a doctor's office.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And I don't know this man.
[CUSTOMER][NEUTRAL] OK, so, uh, uh, why this is uh not covered when performing doctor's office?
[AGENT][NEUTRAL] As per the guidelines of the patient's plan, services in a doctor's office are not covered. This policy covers inpatient hospitalization and outpatient facilities, but no benefits for services in a doctor's office.
[CUSTOMER][NEUTRAL] OK, uh, one more time, can you repeat the general clarification for the documentation purpose?
[AGENT][NEUTRAL] Sure, Services are not covered when performed in a doctor's office.
[CUSTOMER][NEUTRAL] As per the patient plan, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Just a second, uh, what is it for the step for this one, the next step?
[AGENT][NEUTRAL] You would need to contact the patient.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] There's no further action with APL.
[CUSTOMER][NEUTRAL] Yes, uh, so there is no possible to appeal, right?
[AGENT][NEUTRAL] You do have a right to an appeal, but it is a non-covered service.
[CUSTOMER][NEUTRAL] OK, and, uh, OK, uh, may I know the mailing address for the nape.
[AGENT][NEUTRAL] It's [PII]. Sure, [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK, the timely filing?
[AGENT][NEUTRAL] 180 days from the date of denial, which was [PII].
[CUSTOMER][NEUTRAL] So can you uh may I know the fax number?
[AGENT][NEUTRAL] Fax number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, uh, one more time, uh, may I know the uh patient plan name?
[AGENT][NEUTRAL] It is a meddling gap policy.
[CUSTOMER][NEUTRAL] Can, uh can you spell it?
[AGENT][NEUTRAL] M E D as in delta, L I N K Medlink gap.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] GAP, right?
[AGENT][NEUTRAL] G as in golf, A P as in Paul, yes.
[CUSTOMER][POSITIVE] Yes, thank you for that.
[CUSTOMER][NEUTRAL] OK, uh, may I know the effective date?
[AGENT][NEUTRAL] Effective date on the policy is [PII], and the policy is active.
[CUSTOMER][POSITIVE] Yes, OK. Thank you for that.
[CUSTOMER][NEUTRAL] Can, uh, may I know your good name spelling?
[AGENT][NEUTRAL] My name is [PII] [PII].
[CUSTOMER][NEUTRAL] Just OK. Uh, may I have the call reference number?
[AGENT][NEUTRAL] Call reference number is my name and today's date.
[CUSTOMER][POSITIVE] Yes, OK. Thank you, [PII], for your kind assistance. Have a great day.
[AGENT][POSITIVE] Yes [PII], it was my pleasure to assist you with that claim denial reason. Thank you for calling APL, and I hope you have a wonderful day as well. Take care.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yes, you too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.