AccountId: 011433970860
ContactId: 8de9de46-9078-42f8-b0c8-2f1464dbb4d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 214490 ms
Total Talk Time (AGENT): 87193 ms
Total Talk Time (CUSTOMER): 37804 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/8de9de46-9078-42f8-b0c8-2f1464dbb4d3_20250210T14:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm sorry, hi, I'm just calling to check claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, and may I have your name and a good contact number in case we disconnected?
[CUSTOMER][NEUTRAL] My name is [PII] and the number is [PII], direct.
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] Let's see here.
[CUSTOMER][NEUTRAL] 02445118
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] Yes, that's going to be [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] It is for $1,058.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Right. And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Um, yeah, Florida Hospital medicine Services.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Here
[AGENT][NEUTRAL] And it's for codes 99223 and 99497.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, here it is. So I'm showing received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 349.
[AGENT][NEUTRAL] 1966.
[AGENT][NEUTRAL] And on [PII], the claim was denied, and hold on one moment, I'm waiting for that denial reason.
[AGENT][NEUTRAL] Um, the policy provides no benefits for charges made by a doctor for observation care in an inpatient or outpatient setting.
[CUSTOMER][NEUTRAL] OK, that was for observation?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um, can I just, uh, document the appeal timely filing just in case they wanted to do anything with that?
[AGENT][NEUTRAL] Oh, sure. Um, so for appeals, you have 180 days from the denial date?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think that's everything I need besides the reference number.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name on today's date. So again, that's [PII], and then today's date.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're very welcome. Thanks for calling APL [PII]. Have a great week.
[CUSTOMER][NEUTRAL] Bye.