AccountId: 011433970860
ContactId: ad3e55c1-e6cc-4f8d-8f9e-95f9a4603cb6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 318040 ms
Total Talk Time (AGENT): 122420 ms
Total Talk Time (CUSTOMER): 99217 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/ad3e55c1-e6cc-4f8d-8f9e-95f9a4603cb6_20250204T14:00_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, [PII]. My name is [PII]. I'm calling from Saint Francis Hospital to check on the appeal status of a claim.
[AGENT][NEUTRAL] OK, I can definitely help you with the um appeal claim status. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. It's a direct line and the ID number is [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth, [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 want me to check on?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bill?
[CUSTOMER][NEUTRAL] The billed amount is $5710 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold while I take a look at the claim?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] TH
[AGENT][NEUTRAL] Mm mm mm.
[AGENT][NEUTRAL] OK, hello [PII].
[AGENT][POSITIVE] Thank you so much for holding. Thank you so much for holding. I apologize for that wait. So it looks like we received the appeal on [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 355.
[AGENT][NEUTRAL] 5641.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because it was miscellaneous correspondence, um, it was
[AGENT][NEUTRAL] Just miscellaneous documents. The original reason that the claim was denied is because it wasn't a covered service. Um, did the service change?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. So since it's uh non-covered services, can we bill the patient for the balance?
[AGENT][NEUTRAL] So we don't determine patient responsibility because we're not a major medical insurance company. Um, it would be whatever your policies or procedures are on outstanding balances, since it's not covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can we build the, I'm sorry, uh, it's next level of appeal is possible or not?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Um, next level of appeal is possible or not?
[AGENT][NEUTRAL] Uh, it, it, I mean, I can't tell you not to appeal. It wouldn't make sense to you though because it's not a covered charge, so there would be no reason to appeal.
[CUSTOMER][NEUTRAL] OK. Um, do you have, um, can you request for the upheld debtor to be faxed over to us?
[AGENT][NEUTRAL] The appeals explanation of benefits?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what's your fax number?
[CUSTOMER][NEUTRAL] Our fax number is [PII].
[AGENT][NEUTRAL] And should I put attention [PII]?
[CUSTOMER][NEUTRAL] Attention to the patient account number which is 401503776.
[AGENT][NEUTRAL] 401503776.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, well, I'll go ahead and send the explanation of benefits over to you now, [PII]. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Mhm. That would be all. Thank you. And can I ask for call reference number?
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. Again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you [PII] have a good day.
[AGENT][POSITIVE] You're welcome, [PII]. You also and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.