AccountId: 011433970860
ContactId: 9d326ffc-0ad0-4bf3-b630-cb345d563a54
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 316070 ms
Total Talk Time (AGENT): 128332 ms
Total Talk Time (CUSTOMER): 86519 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/9d326ffc-0ad0-4bf3-b630-cb345d563a54_20250312T14:10_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, hi. My name is [PII] and I'm calling for a provider to check any additional information about the claim that has been denied. Please, may I know that this call has been recorded for quality and training purposes. How are you doing today?
[AGENT][NEUTRAL] I'm doing fine, [PII]. How are you?
[CUSTOMER][POSITIVE] Yeah, I'm doing great. Thank you. Thank you so much for asking.
[AGENT][NEUTRAL] Good. So you, you're welcome. And so you're needing to get some additional information on a denied claim, is that correct?
[CUSTOMER][POSITIVE] Yes you are right.
[AGENT][NEUTRAL] Yes, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], and it's a direct line?
[AGENT][NEUTRAL] Thank you and the member's policy number please?
[CUSTOMER][NEUTRAL] 02427221
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This name [PII] and the date of birth, [PII].
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What is the date of service and total build amount please [PII]?
[CUSTOMER][NEUTRAL] Date of service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] With the bill amount of $135 even.
[AGENT][NEUTRAL] And the claim number?
[CUSTOMER][NEUTRAL] Claim number I have.
[CUSTOMER][NEUTRAL] 356-738-9
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you did say the data service is 11-11-2024, is that correct?
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] OK. So yes, I do have this um claim pulled up and how can I help you with that today?
[CUSTOMER][NEUTRAL] Actually, the claim was denied as non-covered procedure. Uh, my question is, is this non-covered as per the patient's plan or the provider's contract?
[AGENT][NEUTRAL] OK, for the date of service and the claim number that you provided for me, this claim was denied because our records indicate the premium for this state of service was not received.
[AGENT][NEUTRAL] Therefore, benefits are not payable. This policy termed as a 55 2024.
[AGENT][NEUTRAL] And there was no other policy active for data service.
[CUSTOMER][NEUTRAL] OK, I got it. Uh, may I know the last updated COB on?
[AGENT][NEUTRAL] We are not a major medical insurance. This is only a hospital indemnity limited benefit plan, so I would not have that information.
[CUSTOMER][NEUTRAL] No worries. And could you please provide me the appeal mailing address for more documentation purpose? Is that possible?
[AGENT][NEUTRAL] [PII] City, [PII], and the zip code is [PII] attention appeals department.
[CUSTOMER][NEUTRAL] Is there any specific form required for an appeal?
[AGENT][NEUTRAL] No, but it must be filed within 180 days from the date of the decision, and again it must be sent to attention appeals department.
[CUSTOMER][NEUTRAL] Office department. Oh got it.
[CUSTOMER][NEUTRAL] And the call reference number going to be?
[AGENT][NEUTRAL] My name along with today's date.
[AGENT][NEUTRAL] And again if you need a copy of this explanation of benefits, you should be able to print that from our portal all by going to [PII].
[CUSTOMER][NEUTRAL] Oh got it.
[CUSTOMER][POSITIVE] Oh, got it. Uh, thank you. Thank you so much for your help.
[AGENT][POSITIVE] OK. Well, you're welcome. And is there anything else I can help you with this morning?
[CUSTOMER][NEUTRAL] Uh, no, that's it for today.
[AGENT][POSITIVE] OK, well, thank you again for calling APO and I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] Sure, bye for now.
[AGENT][NEUTRAL] Um, bye-bye.