AccountId: 011433970860
ContactId: a3668eb4-368d-485b-a079-3f8f08f4f5e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 335209 ms
Total Talk Time (AGENT): 125004 ms
Total Talk Time (CUSTOMER): 224852 ms
Interruptions: 9
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/a3668eb4-368d-485b-a079-3f8f08f4f5e2_20250512T14:56_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Calling APL speaking. May I help you? Yeah, hi, my name is [PII]. My last initial is [PII] like November, calling for claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you, [PII]. And what is the policy number, please?
[CUSTOMER][NEUTRAL] I have to verify claim status for you and what is the policy number, please?
[CUSTOMER][NEUTRAL] The policy number is
[CUSTOMER][NEUTRAL] 02556230
[AGENT][NEUTRAL] Thank you. Uh, one moment. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] And do you have a call back number I can get the call drop?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. Is that OK?
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth, please.
[CUSTOMER][NEUTRAL] OK, and verify the patient's name, date of birth, please.
[CUSTOMER][NEUTRAL] Uh, sorry, you're asking for the patient's date of birth?
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's name and date of birth. So, the patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] OK. And what was the date of service and the amount of the charge? The date of service is [PII] and the total charges is $416 416 dollars even.
[AGENT][NEUTRAL] OK, and the balance after primary insurance?
[CUSTOMER][NEUTRAL] And the balance after primary insurance? Uh, it is $75.
[AGENT][NEUTRAL] OK, thank you, [PII]. Give me one moment, please.
[CUSTOMER][NEUTRAL] I know please.
[AGENT][NEUTRAL] OK, and while I'm looking at claim information, let you know we do have an online service center where providers can check claim status as well as print out the EOB.
[CUSTOMER][NEUTRAL] And while I'm looking at claim information let you know we do have an online service center where providers can check claim status as well as print out the EOB. OK. And that site is at [PII].
[AGENT][NEUTRAL] And that site is at [PII].
[AGENT][NEUTRAL] And you're calling from?
[CUSTOMER][NEUTRAL] And you're calling from? A Medical University Hospital.
[AGENT][NEUTRAL] Uh, let's see. I'm showing that claim processed as office visits are not covered per the policy.
[CUSTOMER][NEUTRAL] I'm showing that claim process as office visits are not covered for the policy.
[CUSTOMER][NEUTRAL] OK. May I know the claim received it?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. And may I know the process date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. And may I know the claim number?
[AGENT][NEUTRAL] 358-513-3.
[CUSTOMER][NEUTRAL] 358-513-3 OK. So primary leftover is $75 copay to the secondary insurance. So why uh it is denied for policy not covered in the patient's plan?
[AGENT][NEUTRAL] According to the patient's policy with us, office visits are not covered.
[CUSTOMER][NEUTRAL] According to the patient's policy with us, offices are not covered. OK, may I know the uh.
[CUSTOMER][NEUTRAL] Member policy name and policy type?
[AGENT][NEUTRAL] It's Medlik, M E D L I N K and it's a secondary supplemental policy.
[CUSTOMER][NEUTRAL] It's Medli M E D L I N K and it's a secondary supplemental policy.
[CUSTOMER][NEUTRAL] OK. And will you please send us the UOB copy to my fax number?
[AGENT][NEUTRAL] OK, what is the fax number?
[CUSTOMER][NEUTRAL] What is the fax number? Uh, is email, email option is available?
[AGENT][NEUTRAL] What is the email address?
[CUSTOMER][NEUTRAL] What is the email address. The email ID is [PII].
[AGENT][NEUTRAL] OK, so the email address is [PII]?
[CUSTOMER][NEUTRAL] OK, so the email address is [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, and is there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] OK. Is there anything else I can assist you with today? Uh, what will be the turnaround time for the email to be received?
[AGENT][NEUTRAL] Uh, don't know, but it should be received in a few moments, definitely before the end of the day.
[CUSTOMER][NEUTRAL] I don't know, but it should be received in a few moments definitely before the end of the day. OK, may I know the mailing address and timely filing limit?
[AGENT][NEUTRAL] Uh, you have up to 180 days from the time the claim was processed to submit an appeal. You must submit a letter stating the reason for the appeal and let me know when you're ready I can give you the address.
[CUSTOMER][NEUTRAL] And you have up to 180 days from the account of the claim with process to submit an appeal. You must submit a letter stating the reason for the appeal, and let me know when you're ready. I give you the address. Yes, I'm ready.
[AGENT][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII]. Thank you so much and uh may I know the call reference number for our conversation?
[AGENT][NEUTRAL] 8950.
[AGENT][NEUTRAL] Uh, if you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] Uh, if you like, you may use my name at [PII]. O[PII] May I know your name, please?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] It's [PII]. And the timely filing limit for sending an appeal is 180 days from process date, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Correct. OK, so thank you so much and have a nice day.
[AGENT][POSITIVE] Alright, you're welcome thanks for calling APL bye.
[CUSTOMER][POSITIVE] Alright, you're welcome. Thanks for calling APL. bye.