AccountId: 011433970860
ContactId: 8e578395-4fc5-46cc-b8a9-255da7636d0f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 380799 ms
Total Talk Time (AGENT): 94717 ms
Total Talk Time (CUSTOMER): 104178 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/8e578395-4fc5-46cc-b8a9-255da7636d0f_20250226T15:12_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from provider's office to look for the claim status.
[AGENT][NEUTRAL] OK, just so I can help you with claim status. May I get your call back number please?
[CUSTOMER][NEUTRAL] Mm, yes, of course. It is [PII].
[AGENT][NEUTRAL] Thank you. And what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes. Uh, patient policy number is 101678802 M like Mike L like Lima 88.
[CUSTOMER][NEUTRAL] And the member's name is [PII] [PII], and date of birth is [PII].
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what is the date of service, please?
[CUSTOMER][NEUTRAL] Um, it is [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] It's $1,809 even.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Um, give me one second.
[CUSTOMER][NEUTRAL] Um, it is $711.02.
[AGENT][POSITIVE] Thank you so much. And one last question, can you please give me the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Mhm. Yes, it is uh Pediatrics Medical Group of Florida INC.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold [PII] while I look up this claim for us and I'll be right back.
[CUSTOMER][POSITIVE] Mhm. Sure, take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Cool.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I've got the claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 355-0511.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was denied because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, for this claim, uh, do you have any suggestion what you have to do next?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Mhm. OK. Um, can I get the card to claim mailing address?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yes, uh, um, my mailing address is [PII].
[CUSTOMER][NEUTRAL] That.
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, what is the timely filing to submit this claim?
[AGENT][NEUTRAL] We don't have one.
[CUSTOMER][NEUTRAL] Oh, OK. Uh, can I get the uh mailing address?
[AGENT][NEUTRAL] It's the same address I gave you.
[CUSTOMER][NEUTRAL] Oh, OK. So there is no timely filing for appeal as well, right? Or you do have?
[AGENT][NEUTRAL] Not for a correction. Now, not for a correction, but if you want to appeal, you have 180 days from the date the claim was initially processed and you need a letter while you're appealing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. May I know when the claim was denied?
[AGENT][POSITIVE] Yes ma'am, let me look that up for you real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Uh, got it. Thank you so much for this one, sorry. Um, can I get the call reference number?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name and today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII], and thank you very much for your assistance and have a good day. Bye for now.
[AGENT][POSITIVE] You too, yes, [PII], thank you. Thanks for calling ABM.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Bye-bye.