AccountId: 011433970860
ContactId: 87781fb5-99b5-4e82-b004-f6a1f65b4dcf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 443299 ms
Total Talk Time (AGENT): 156167 ms
Total Talk Time (CUSTOMER): 217198 ms
Interruptions: 12
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/87781fb5-99b5-4e82-b004-f6a1f65b4dcf_20250122T18:16_UTC.wav
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[AGENT][NEUTRAL] American Public Lia. How may I.
[CUSTOMER][NEUTRAL] supply.
[CUSTOMER][NEUTRAL] Hi, my name is [PII] from the provider office checking on the claims.
[AGENT][NEUTRAL] Could you repeat your name for me please?
[CUSTOMER][NEUTRAL] Did you receive your
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, and [PII], may I please have a call back?
[CUSTOMER][NEUTRAL] Can I have your name please?
[AGENT][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes. Would you like for me to spell that for you?
[CUSTOMER][NEUTRAL] Ah yes.
[AGENT][NEUTRAL] It is spelled [PII]
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] [PII] last initial of [PII] and today's date will be used as the call reference.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Last initial [PII] and today.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. May I please have a callback number and then the policy number?
[CUSTOMER][NEUTRAL] Uh, sure, the callback number is [PII] and it's a direct line.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Member ID is [PII] and [PII].
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] name and date of birth. And my name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][POSITIVE] And thank you so much, [PII] for verifying the policy. How may I assist you?
[CUSTOMER][NEUTRAL] I'm checking on the bill status.
[AGENT][NEUTRAL] May I have the date of service and total bill?
[CUSTOMER][NEUTRAL] Sure, the date of service is [PII]. And the total charges are $303 even that is 303.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that is for data service of $22224 total bill charge $303. I'm pulling that information up for you now.
[CUSTOMER][NEGATIVE] This is ridiculous
[CUSTOMER][NEUTRAL] 30.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you can also check claim status via our secured portal that is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And it does look like we received that claim on for 5 [PII].
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] It was processed on 48 [PII] 24.
[CUSTOMER][NEUTRAL] It was on the board.
[AGENT][NEUTRAL] That claim number is 344.
[CUSTOMER][NEUTRAL] 24
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] 0853. It is showing that that claim process and it denied that office procedures are not covered under this plan. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] 08
[CUSTOMER][NEUTRAL] all this procedures.
[CUSTOMER][NEUTRAL] Covered under this plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I'm just checking on the appeal status appeal.
[AGENT][NEUTRAL] I don't see that there's an appeal listed.
[CUSTOMER][NEUTRAL] I don't see that there's gonna be mhm.
[AGENT][NEUTRAL] Are you stating that you, you also submitted appeal on that previous denied claim?
[CUSTOMER][NEUTRAL] Are
[CUSTOMER][NEUTRAL] Yeah, uh, yeah, a bill was submitted on [PII] through fax.
[AGENT][NEUTRAL] Let me check to see if we have an image.
[CUSTOMER][NEUTRAL] Let me check with you. Mhm.
[AGENT][NEUTRAL] And I'm pulling up an image now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it looks like you all submitted in medical records?
[CUSTOMER][NEUTRAL] So it looks like.
[CUSTOMER][NEUTRAL] Yes, for medical records.
[AGENT][NEUTRAL] OK, so we did receive the medical records, but this member does not have any benefits, so this is a non-covered service for their policy.
[CUSTOMER][NEUTRAL] OK, so we did receive the medical records, but this does not have the.
[CUSTOMER][NEUTRAL] a non-covered service for their.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But we have, uh, we have submitted with EOB and complete medical records.
[AGENT][NEUTRAL] OK, so if the member does not have that benefit, we can't.
[CUSTOMER][NEUTRAL] So you did receive it mhm.
[AGENT][NEUTRAL] Reimbursed, we can't submit any payment. The member does not have that benefit coverage.
[CUSTOMER][NEUTRAL] Reimbursed, we can't submit any payments. The member does not have the benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know when it was denied?
[AGENT][NEUTRAL] It was received on.
[CUSTOMER][NEUTRAL] It was received on mhm.
[AGENT][NEUTRAL] [PII] and it was denied on [PII].
[CUSTOMER][NEUTRAL] Yep
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] So the previous claim denied correctly.
[CUSTOMER][NEGATIVE] So the previous one did not greatly.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. Can I?
[CUSTOMER][NEUTRAL] The call reference number?
[AGENT][NEUTRAL] As stated at the beginning of the call, it is Tarika, last initial of H and today's date.
[CUSTOMER][NEUTRAL] And before, yeah, before that, could you fax me the correspondence.
[AGENT][NEUTRAL] Which one would you like?
[CUSTOMER][NEUTRAL] The recent [PII], which was denied.
[AGENT][NEUTRAL] OK, so that correspondence is not going to generate an EOB. It was an appeal that was requested for review so that appeal was stating that it was still denied correctly. So the only EOB that you will receive is the first claim that denied.
[CUSTOMER][NEUTRAL] OK, so a correspondence is not going to generate any.
[CUSTOMER][NEUTRAL] It was an appeal that was requested for review so that was that it was denied so the only EOB that you receive.
[CUSTOMER][NEUTRAL] that not.
[AGENT][NEUTRAL] As procedure is not covered.
[CUSTOMER][NEUTRAL] And procedure is not over.
[CUSTOMER][NEUTRAL] OK, could you fax me that one? Uh, yes.
[AGENT][NEUTRAL] Are you still needing that LOB?
[AGENT][NEUTRAL] May I have that fax number please?
[CUSTOMER][NEUTRAL] The fax number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And attention
[CUSTOMER][NEUTRAL] Attention to my name.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's [PII]
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, and is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Is there anything else
[CUSTOMER][POSITIVE] Uh, that's it for now. Have a great day. Bye bye.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. You have a great day as well.
[CUSTOMER][POSITIVE] You're welcome. Thank you for calling American Pub Supply. Have a great day as well.