AccountId: 011433970860
ContactId: beb9ccad-6cf5-4ce1-a622-75bee06e997f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 319059 ms
Total Talk Time (AGENT): 119265 ms
Total Talk Time (CUSTOMER): 144916 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/beb9ccad-6cf5-4ce1-a622-75bee06e997f_20250224T17:20_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Uh, good morning. Uh, this is [PII] calling from the provider office regarding about the claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you and I apologize, your name is again?
[CUSTOMER][NEUTRAL] My name is [PII], and last of my name is gonna be [PII].
[AGENT][NEUTRAL] OK, thank you. And [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, before that your name is [PII], am I right?
[AGENT][NEUTRAL] Sure. Uh yes, sir. [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII]. I, I appreciate for that. And the policy number is gonna be 02003104 M as in Mary, L as in Lima 8.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, it's gonna be definitely I can give you a [PII].
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name is.
[CUSTOMER][NEUTRAL] [PII] and date of birth is on [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] Sure, the date of service is [PII] and the total charge amount is gonna be $27.87.
[AGENT][POSITIVE] OK, thank you one moment.
[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. That site is at secured. AM as in [PII]. And you're calling from?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] And the name of the provider's office?
[CUSTOMER][NEUTRAL] Nicholas [PII]'s pediatric.
[AGENT][NEUTRAL] OK, um, showing the claim process is policy provides no benefits for treatment of conditions other than for sickness or an injury as defined by the policy.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is there anything else, [PII], I can assist you with today?
[CUSTOMER][NEUTRAL] Yeah, what is the I think the reason for that? The, uh, what is the general claims it is?
[AGENT][NEUTRAL] Well, as I said, if the policy doesn't cover any services other than for sickness and injury as defined by the policy, per the diagnosis code, it does not show that it was for a sickness or an injury.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you said the DX is not covered under the uh pay plan, am I right?
[AGENT][NEUTRAL] Correct. Services other than for sickness or an injury is not covered under the policy.
[CUSTOMER][NEUTRAL] OK, so actually, uh, I just want to know the few, uh, uh, facts we have. So we have forwarded recording that DX is not covered for the injury death, so it is not payable the CPD code 93,010. So we have forwarded recording and as per the recording, uh, say it was, uh, with, uh, bill with DX.
[CUSTOMER][NEUTRAL] So we have set a fax on [PII]. I just want to know what is the latest status for this fax.
[AGENT][NEGATIVE] I don't show it's been received. I don't show we received any appeal.
[CUSTOMER][NEUTRAL] No, uh, we have sent a fax.
[AGENT][NEUTRAL] Well, I don't show we received a fax.
[CUSTOMER][NEUTRAL] The fax number is [PII]. Is it correct?
[AGENT][NEUTRAL] Uh, that is correct fax number. Yes, sir.
[CUSTOMER][NEUTRAL] Yeah, we, but we, uh, we have sent it on [PII].
[AGENT][NEGATIVE] We have not received it. I don't show it's been received.
[CUSTOMER][NEUTRAL] Mm, OK, so what are the next step do I need to do for this one?
[AGENT][NEUTRAL] Are you trying to submit an appeal?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, but the thing is that earlier we have already, uh, sent a, uh, deal with fax and it was already transmitted on we have sent submitted on [PII]. Just hold please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, well, like I said, I don't show we received it, so you can either remail the appeal letter, um, or you can mail it to our office.
[CUSTOMER][NEUTRAL] Um, yes sir.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, thank you so much and the call reference number.
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name in today's date.
[CUSTOMER][POSITIVE] OK, thank you so much PR I appreciate it. OK, have a wonderful rest of the day. Bye now.
[AGENT][POSITIVE] Alright, you too, [PII]. Thanks for calling ATL. Bye.
[CUSTOMER][POSITIVE] Thank you bye.