AccountId: 011433970860
ContactId: 7cb58ff5-5da6-400a-a3a0-a73056232012
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 424850 ms
Total Talk Time (AGENT): 113509 ms
Total Talk Time (CUSTOMER): 116957 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/7cb58ff5-5da6-400a-a3a0-a73056232012_20250123T18:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for Doctor She. Please note this call will be monitored and recorded for quality and training purposes. I'm calling to check on the claim status. How are you doing today, [PII]?
[AGENT][POSITIVE] I'm good, thank you. I'm happy to check on a claim for you. What is the patient's policy number?
[CUSTOMER][NEUTRAL] The policy number is 02.
[CUSTOMER][NEUTRAL] 45
[CUSTOMER][NEUTRAL] 592 6
[AGENT][NEUTRAL] All right, let me pull this up one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is going to be [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you and then what is the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the bill amount is $790.68 even.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Not showing any claims on file. They just service 1221 [PII].
[CUSTOMER][NEUTRAL] The date of service is [PII]. I'm so sorry.
[AGENT][NEUTRAL] I, I apologize. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The bill amount was for $790.68.
[CUSTOMER][POSITIVE] You're right.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Appreciate your patience here one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So it looks like we did receive this claim. It was received on [PII] or I'm sorry, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, the the claim was denied. Um, it looks like the plan only allows for payment for outpatient surgery in a hospital or physician's office. Therefore, there were no benefits payable.
[CUSTOMER][NEUTRAL] May I know the delayed date of the claim?
[AGENT][NEUTRAL] Uh, claim was denied [PII].
[CUSTOMER][NEUTRAL] OK. It was denied for non-covered charges as per the patient plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] For documentation purpose, may I know the mailing address?
[AGENT][NEUTRAL] Play mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment. [PII].
[CUSTOMER][NEUTRAL] OK. So for documentation purpose, the appeal mailing address is [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And may I know the time of filing limit to submit an appeal?
[AGENT][NEUTRAL] Uh, within 180 days of decision.
[CUSTOMER][NEUTRAL] 180 days from the decision date.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So just a moment. I will double check here.
[CUSTOMER][NEGATIVE] The procedure code which was denied is
[CUSTOMER][NEUTRAL] So, all the procedure code was deed for the same reason?
[AGENT][NEUTRAL] Uh, yes, it looks like what the patient was seen for was not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment, please.
[CUSTOMER][NEUTRAL] I'm checking with the last procedure code.
[CUSTOMER][POSITIVE] All right. Thank you so much for your patience. And uh may I know the claim number of this claim?
[AGENT][NEUTRAL] 343-072-5.
[CUSTOMER][NEUTRAL] OK, for documentation purpose, there is uh another claim which was denied as a duplicate, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Perfect. Thank you. And may I know the call uh call reference number for this call?
[AGENT][NEUTRAL] Call reference is my name with my last initial and today's date. My name again is [PII], that's [PII] Last initial to my name is [PII].
[CUSTOMER][POSITIVE] Perfect. Thank you so much for your assistance, [PII]. Have a lovely day. Take care.
[AGENT][NEUTRAL] You too bye bye.