AccountId: 011433970860
ContactId: 85473bd7-414a-44c8-8f2a-595e0ffaf651
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 471859 ms
Total Talk Time (AGENT): 184442 ms
Total Talk Time (CUSTOMER): 137583 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/85473bd7-414a-44c8-8f2a-595e0ffaf651_20250414T19:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, [PII], uh, this is [PII] calling for provider to check on the status of an appeal that was submitted for a previously denied claim. Please note this call will be monitored and recorded for quality and training purposes.
[AGENT][POSITIVE] I, I'll be happy to assist you, [PII]. May I have a policy number?
[CUSTOMER][NEUTRAL] It's uh the policy number is 01617605 M as in Mike, L as in Lima, 8.
[AGENT][POSITIVE] Thank you. May I have a good callback number for you?
[CUSTOMER][NEUTRAL] Callback number [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim. May I have date of service or claim number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do you have service [PII]?
[AGENT][NEUTRAL] Total bill amount?
[CUSTOMER][NEUTRAL] For the $1,352.55.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] Still searching one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was the uh pill sent?
[AGENT][NEUTRAL] In the form of a letter was sent as a claim?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, that one I'm not sure, uh, but the appeal was submitted to [PII].
[AGENT][NEUTRAL] OK, let me
[CUSTOMER][NEUTRAL] And it was submitted on [PII].
[AGENT][NEUTRAL] OK, let me see if I can get this pulled up.
[AGENT][NEUTRAL] So it looks like you're appealing claim number 352-0287 and which services were denied as no office treatment, is that correct?
[CUSTOMER][NEUTRAL] Um, claim number one what.
[CUSTOMER][NEUTRAL] I'm having a different claim number 354-9250.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and that's the claim that I'm looking at now let me see.
[AGENT][NEUTRAL] OK, so you send it in as a request for reconsideration.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, because it looks like that this claim processed from the 352-028-7 in which it processed as no office treatment.
[AGENT][NEUTRAL] Let me see if there's a letter out here. One moment. Sometimes they will attach the ladder. Let me see if there's a letter out here one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm not showing any letter out here for this appeal process. It looks like they processed the claim according to the policy. So what I'll do is I'll write this up, send it over to the appeals department so that they can get a letter out to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You're so welcome, [PII].
[CUSTOMER][NEUTRAL] Uh, but which claim number?
[CUSTOMER][NEUTRAL] 354-9250 or 3520287?
[AGENT][NEUTRAL] The original claim processed under 352-0287. So when you guys resubmitted, it processed under 354-9250. So I'll send this one over as the appeal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so this.
[CUSTOMER][NEUTRAL] OK, cancellation one word. And may I know the turnaround time for this?
[AGENT][NEUTRAL] In anywhere from 7 to 10 business days, it doesn't necessarily take as long.
[CUSTOMER][NEUTRAL] 7 to 10 business days.
[CUSTOMER][NEUTRAL] OK. Is there any ticket number for this review?
[AGENT][NEUTRAL] No, the confirmation will be my name which is [PII] Last initial is [PII] along with today's date.
[CUSTOMER][NEUTRAL] Request?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much and uh call reference, uh your name and to receive, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Uh, and also may I know the original claim processed it.
[AGENT][NEUTRAL] Yes, the claim was processed on.
[AGENT][NEUTRAL] Sorry, just waiting on the system.
[CUSTOMER][POSITIVE] Mm. Yeah, no problem.
[AGENT][NEUTRAL] Looks like 1022 2024.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And another claim process it?
[AGENT][NEUTRAL] The 14.
[CUSTOMER][NEUTRAL] The other claim number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on, let me see.
[AGENT][NEUTRAL] 352-0287 processed on [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] The claim ended in 9250, processed on [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, thank you so much. And both are denied for the same reason, right? Obviously that are not covered?
[AGENT][POSITIVE] That is correct.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And is there any uh denial reason for the other CPT codes?
[AGENT][NEUTRAL] There is no office.
[CUSTOMER][NEUTRAL] And then the office is it?
[AGENT][NEUTRAL] The office visit is not covered, the office treatment is not covered.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh, office treatment is not covered, not covered as for the plan, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. And when the patient plan type?
[AGENT][NEUTRAL] This is the
[CUSTOMER][NEUTRAL] Medicare supplement plan.
[AGENT][NEUTRAL] No, this is their gap policy. It follows their primary.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah policy for the primary.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII], and uh have a wonderful day. Take care. Bye.
[AGENT][POSITIVE] [PII], you're so welcome. And thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm