AccountId: 011433970860
ContactId: 7a74a05f-e526-45b0-84f0-f821435d41f3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 271369 ms
Total Talk Time (AGENT): 86498 ms
Total Talk Time (CUSTOMER): 76793 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/7a74a05f-e526-45b0-84f0-f821435d41f3_20250324T16:27_UTC.wav
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[AGENT][POSITIVE] Thank you for calling A [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, hi, my name is [PII], and I'm calling on behalf of Tegris Health Edmund Hospital on a recorded line. Uh, I just have a question about a claim we have here if we could go over that please.
[AGENT][POSITIVE] Yes ma'am, I can help you with your claim um Ms. [PII], can I please get your callback number just in case the call gets disconnected I'll be able to call you back.
[CUSTOMER][NEUTRAL] Absolutely it's [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, uh, patient's name and date of birth is [PII]. Date of birth is [PII]. Policy number is 00974225.
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[AGENT][NEUTRAL] Alright, and then what is the date of service for [PII]?
[CUSTOMER][NEUTRAL] Here I have let me see, it is [PII].
[AGENT][NEUTRAL] And the charge amount please?
[CUSTOMER][NEUTRAL] It was $194.
[AGENT][NEUTRAL] OK and then what is um the claim number that you're calling about? Do you know that?
[CUSTOMER][NEUTRAL] Uh, let me double check. See, yes, um, it is 346-9300.
[AGENT][NEUTRAL] OK, let me look her up her claim up real quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] OK, so looking at this claim, it was denied because the policy provides no benefits for any condition other than sickness or injury.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else, Miss [PII] I can help you with before we go?
[CUSTOMER][NEUTRAL] Uh, yes, ma'am, um, before we disconnect you, may I just get a reference number please, and I just got another um question. What is y'all's, um, timely filing for receiving claims and eels?
[AGENT][NEUTRAL] Uh, the appeals need to be done, um, 180 days from the date the claim was initially processed and you'll need to send the letter why you're appealing.
[AGENT][NEUTRAL] And um for regular claims for just submitting your first claim, there's not a timely filing limit as long as the insured was covered on the data service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Really?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] That's the first time I've ever heard that. That's great. OK, thank you for that.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And then, um.
[AGENT][NEUTRAL] The reference number would be my name and today's date.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] OK great thank you so much for everything. I appreciate it.
[AGENT][POSITIVE] You're very welcome, [PII]. I hope you have a wonderful day and we thank you for calling APL.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Mhm bye bye, ma'am.