AccountId: 011433970860
ContactId: b4cf607b-7b98-4d1c-b253-642c8a9cf9f3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 482959 ms
Total Talk Time (AGENT): 129952 ms
Total Talk Time (CUSTOMER): 252211 ms
Interruptions: 3
Overall Sentiment: AGENT=1.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/b4cf607b-7b98-4d1c-b253-642c8a9cf9f3_20250401T14:40_UTC.wav
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[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] from provider office checking for a claim status.
[AGENT][POSITIVE] All right, [PII], I'm happy to check on a claim for you today. Can I get the patient's policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] A patient policy ID number is.
[CUSTOMER][NEUTRAL] 01988243 my Larry 8.
[AGENT][POSITIVE] Thank you. And do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, I do. The callback number of mine is [PII], and this is my direct line.
[AGENT][NEUTRAL] Thank you, [PII]. Can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] [PII] date of birth [PII].
[AGENT][NEUTRAL] Thank you. And then what is the date of service?
[CUSTOMER][NEUTRAL] One.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, not really.
[AGENT][NEUTRAL] And the bill amount?
[CUSTOMER][NEUTRAL] $213,619.90.
[CUSTOMER][NEUTRAL] I the.
[AGENT][NEUTRAL] Do you have an amount after the primary?
[CUSTOMER][NEUTRAL] After the primary.
[CUSTOMER][NEUTRAL] One second. $3150.01.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Right, so it looks like we did receive this claim, claim was received [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] There was a benefit payment made in the amount of $500.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, with this check, that was the maximum benefit payable for the state of service.
[AGENT][NEUTRAL] Claim was processed on [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Got it. Actually I have a specific concern regarding this claim, and that is, uh, in that we received a claim and we got a payment also, but the amount which we received does not meet our expected reimbursement for the reason we sent under payment appeal, and that appeal was sent on [PII]. [PII], could you please find it, did you receive any appeal on file for this day of service or not?
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] So I don't you
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Well I.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I that
[CUSTOMER][NEUTRAL] We make a.
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] We did receive the appeal, um.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was received on [PII].
[CUSTOMER][NEUTRAL] Hey what is sir.
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, sir. Uh, I'm checking the appeal which was sent on [PII]. What about this one?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Don't show anything for [PII]. 1 moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, sure, sure.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] You, um, there have been two appeals sent on this particular claim. The original one was received [PII], processed on [PII]. We did receive another one reported on [PII], that's in progress, so we did receive the second one.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, again, please, [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII] and it was still under process, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Can I get the AP number or ID?
[AGENT][NEUTRAL] Uh, there's not one assigned to it as of now.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Do you have a DCN number?
[CUSTOMER][NEUTRAL] Of this appeal?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] There's no claim number associated with it at this time. It's in progress, so I don't have anything to provide.
[CUSTOMER][NEUTRAL] OK. The last appeal which was sent on [PII] was received on [PII] and it was still under process and there is no appeal, uh, number or ADCN number yet, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] May I know what is your turnaround time for processing appeal?
[AGENT][NEUTRAL] Uh, pills can take up to 30 days.
[CUSTOMER][NEUTRAL] OK, I got it.
[CUSTOMER][NEUTRAL] No case ID or DCN.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Dispute number for this bill.
[CUSTOMER][POSITIVE] Got it. Thank you so much. Uh, maybe that's what I've been needing for today, [PII]. Can I get a call reference for a conversation?
[AGENT][NEUTRAL] Call references my name with my last initials in today's date. My name again is [PII], that's [PII] Last initial is [PII].
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And today's day, right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][POSITIVE] Thank you [PII]. That's what I've been needing for today. Enjoy the rest of your day.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Have a good day.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye