AccountId: 011433970860
ContactId: 88e688af-6ca8-4227-b0bf-d3ec2800406e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 246919 ms
Total Talk Time (AGENT): 125675 ms
Total Talk Time (CUSTOMER): 74696 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/88e688af-6ca8-4227-b0bf-d3ec2800406e_20250113T13:43_UTC.wav
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[AGENT][POSITIVE] Morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check the claim status. And [PII], can you please spell your name?
[AGENT][POSITIVE] It would be my pleasure to spell my name, [PII]. It's [PII]
[AGENT][NEUTRAL] First initial last name, [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. It's a direct line.
[AGENT][POSITIVE] Thank you, [PII], and it would be my pleasure to assist you with claim status. What is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] It's 01845835 M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] Thank you, [PII], and the patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And [PII], do you have a claim number or date of service?
[CUSTOMER][NEUTRAL] I do have both.
[AGENT][NEUTRAL] What is the claim number?
[CUSTOMER][NEUTRAL] 3491912.
[AGENT][NEUTRAL] And what is the facility name, please?
[CUSTOMER][NEUTRAL] Pediatrics Medical Group.
[AGENT][NEUTRAL] And the bail them out, please.
[CUSTOMER][NEUTRAL] $232 even.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And it would be my pleasure to assist you with that claim status. [PII], I'm showing that we received that claim on [PII], processed and denied on [PII], and it was denied because services are not covered when performed in a doctor's office.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Is this the patient responsibility?
[AGENT][NEUTRAL] And that is for the policy, the patient plan.
[AGENT][NEUTRAL] Now, we're secondary, not major medical. We do not determine patient responsibility.
[CUSTOMER][NEUTRAL] OK. And also, uh, can I get the
[CUSTOMER][NEUTRAL] A mailing address on the timely filing to file an appeal.
[AGENT][NEUTRAL] Mhm. The timely filing for an appeal is 180 days from the date of denial.
[CUSTOMER][NEUTRAL] Mhm. And the address?
[AGENT][NEUTRAL] And the
[AGENT][NEUTRAL] It would be to uh claims appeals department.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK. Do you have any fax to send an appeal?
[AGENT][NEUTRAL] You can fax it to our claims department at [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. It's [PII], right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. And uh what is it that the selling limit to submit and collect a claim?
[AGENT][NEGATIVE] No tell me filing for corrected claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, [PII]. And what would be the call reference number I'm done for the day?
[AGENT][POSITIVE] The call reference number is my name and today's date, and I spell my name [PII] first initial of my last name is [PII] and [PII], it was a pleasure to assist you with that claim status. I hope you have a wonderful day and thank you for calling APL.
[CUSTOMER][POSITIVE] Have a great day. Bye.
[AGENT][POSITIVE] You too. Thank you. Bye bye.