AccountId: 011433970860
ContactId: b78cb56f-4a6c-49ed-a0f3-81f4c0f76021
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 436470 ms
Total Talk Time (AGENT): 140803 ms
Total Talk Time (CUSTOMER): 221919 ms
Interruptions: 5
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/b78cb56f-4a6c-49ed-a0f3-81f4c0f76021_20250312T19:46_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, OK, I'm [PII]. I'm calling from provider's office. I'm calling to know the claim status. Could you spell your name, please?
[AGENT][NEUTRAL] Sure, it's [PII] last initial [PII] and [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um, sorry, the callback number? Policy number. OK. The policy number is 1426647 M as in Mike, L as in Lima 8.
[AGENT][NEUTRAL] No policy number?
[AGENT][NEUTRAL] Thank you. And what is the callback number, please, in case the call drops?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] the extension [PII].
[AGENT][NEUTRAL] OK, thank you. And Ms. [PII], verify the patient's name, date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII], and the date of birth is [PII].
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] OK, thank you. And you said you're calling for claim status, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] [PII] and the charge amount is $3,089 even.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, and you said date of service [PII] at [PII] in amount of $3,0089 correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what was the balance after primary insurance process the claim?
[CUSTOMER][NEUTRAL] was
[CUSTOMER][NEUTRAL] Um, I'm sorry, the charge amount is $135. And after primary processed $50 even was the less balance.
[AGENT][NEUTRAL] OK, so let me just clarify. So the date of service is [PII] and the total charge amount is 3,089 or 135.
[CUSTOMER][NEUTRAL] 7:40
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Um, not them. It's $740 even. I'm sorry for the confusion.
[AGENT][NEUTRAL] So the total charge amount is $740 correct?
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the balance after primary?
[CUSTOMER][NEUTRAL] $50 even.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And while I'm looking at claim information, just to let you know, we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[CUSTOMER][NEUTRAL] People.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And you're calling from?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Pediatrics Medical Group.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] OK, I'm showing that claim process as office visits are not covered per the policy.
[CUSTOMER][NEUTRAL] Like.
[CUSTOMER][NEUTRAL] Off the seas are not covered for the policy. May I know, can we bill the patient?
[AGENT][NEUTRAL] Per the policy.
[AGENT][NEUTRAL] Uh, we can't give patient responsibility. We can only verify how the claim was processed, which was, is not covered.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the time finding limit?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Appeal timely filing limit.
[AGENT][NEUTRAL] You have up to 180 days from the time the claim was processed to submit an appeal, and you must submit a letter stating the reason for the appeal.
[CUSTOMER][NEUTRAL] May I know when was the claim processed?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much. And I have one more plan.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] For the same patient or a different patient?
[CUSTOMER][NEUTRAL] Different patient.
[AGENT][NEUTRAL] OK, give me one moment, please.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Really.
[AGENT][NEUTRAL] OK. What is the next policy number?
[CUSTOMER][NEUTRAL] 018 01685588 M as in Mike, L as in Lima 8.
[AGENT][NEUTRAL] Thank you. One moment. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Uh, they're not show that patient under this policy, and you said the policy number is 1685588?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 01685588 ML 8.
[AGENT][NEUTRAL] OK. Yes, ma'am. I don't show that patient under this policy.
[CUSTOMER][NEUTRAL] Oh, there's no patient found?
[AGENT][NEUTRAL] That patient is not on this policy.
[CUSTOMER][NEUTRAL] Could you verify from the name and date of this the patient have any other policy?
[AGENT][NEUTRAL] Uh, what's the first and last name?
[CUSTOMER][NEUTRAL] [PII], um, you want me, uh, can you spell it?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] First name is [PII].
[CUSTOMER][NEUTRAL] [PII], and the last name is
[CUSTOMER][NEUTRAL] [PII]. Sorry, [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] So I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] Yes, I don't show that patient in our system.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for your help today, [PII]. May I know the call reference number?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. You may use my name in today's date, and is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that would be all. Thank you.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL Monica. Have a great day.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] You too. Bye-bye.