AccountId: 011433970860
ContactId: bd55b173-d66b-42c4-bbf2-dafb1bded1cf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 341010 ms
Total Talk Time (AGENT): 113315 ms
Total Talk Time (CUSTOMER): 142334 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/bd55b173-d66b-42c4-bbf2-dafb1bded1cf_20250303T20:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I am with Covenant Medical Group. I'm calling to get claim status for a patient.
[AGENT][NEUTRAL] Sure, I can check on a claim for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] 02110253
[AGENT][NEUTRAL] OK, and then uh what was the name and date of birth for the insured please?
[CUSTOMER][NEUTRAL] [PII] last name is.
[CUSTOMER][NEUTRAL] [PII] Date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that [PII], and then what was the date of service for this claim?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the bill amount is 404 even.
[AGENT][NEUTRAL] OK, that was, uh, I'm sorry, you said [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, alright, thank you, one please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we did receive this claim, [PII], we were unable to pay a benefit as uh this policy does not provide benefits for diagnostic testing.
[CUSTOMER][NEUTRAL] OK, and when did you receive it?
[AGENT][NEUTRAL] Oh, sure, give me just a moment.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, uh, this claim was received [PII], and it was processed, uh, [PII].
[CUSTOMER][NEUTRAL] OK, and what is the claim number for this?
[AGENT][NEUTRAL] That is 347-858-9.
[CUSTOMER][NEUTRAL] OK, and you said it was basically, uh, is that it has to do with the policy, is that correct?
[AGENT][NEUTRAL] Right, uh, it's not covered under their policy. And if you'd like, [PII], I can send you a copy of this EOB.
[CUSTOMER][NEUTRAL] I do have the portal. I just got the access to the portal and I was trying to look it up through the portal before I called and it stated there was no claim found. Would I be able to look this claim up in the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] the information that I did to you.
[AGENT][NEUTRAL] With
[AGENT][NEUTRAL] Yes, with that claim number you should.
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] Go ahead and try to look it up and.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, this is the first time I even tried to do anything but with, with everything going on.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] A lot of, a lot of our portals are kind of, kind of going slow on this. I'm like, OK, we kind of need y'all to go a little bit faster in a way.
[AGENT][NEUTRAL] It's Monday even for the computers.
[CUSTOMER][POSITIVE] It is, it is 100%. I, I always say.
[CUSTOMER][NEUTRAL] Ah
[AGENT][NEUTRAL] Alrighty well, [PII], was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Uh, how do you spell your name, ma'am?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] And first initial of your last name ma'am?
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] I'll send that number with this call.
[AGENT][NEUTRAL] Uh, it would just be my first name, last initial, and, oh, sorry.
[CUSTOMER][NEUTRAL] I'll be uh
[CUSTOMER][NEUTRAL] Uh, I was gonna ask, timely filing, how long do we have to file a new claim with y'all?
[AGENT][NEGATIVE] Uh, there's no timely filing limit.
[CUSTOMER][NEUTRAL] OK, and then since this claim did get denied, but understanding with the with the policy, how long do we have to appeal a claim?
[AGENT][NEUTRAL] So appeals are going to be, uh, have to be within 180 days of the process date.
[CUSTOMER][POSITIVE] Awesome and my last question is Kevinant in network with y'all or out of network?
[AGENT][NEUTRAL] So this plan is actually not a part of any sort of network. Um, it is a limited indemnity medical plan.
[CUSTOMER][NEUTRAL] OK, so pretty much it's well it'll come back as out of network, correct?
[AGENT][NEUTRAL] So it essentially just pays a set dollar amount per covered procedure or office visit, um, it doesn't do any percentages or anything like that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, that's why I wanted to make sure. Other than that.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Other than that, my reference number is gonna be your name in today's date, is that correct?
[AGENT][NEUTRAL] Yeah, first name, last initial and today's date.
[CUSTOMER][POSITIVE] Awesome, I do appreciate your help with everything like I said, I will look in the portal, see if I can find, find it in there and if I can't then I'll call back and get a copy of the.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Just give us a call right back. Sounds good. Yes, ma'am. Well, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Thank you you too bye.
[AGENT][POSITIVE] Thank you, bye bye.