AccountId: 011433970860
ContactId: c26aa2f1-7d16-4d7c-a748-4fb4c4f9f391
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 280260 ms
Total Talk Time (AGENT): 87641 ms
Total Talk Time (CUSTOMER): 66540 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/c26aa2f1-7d16-4d7c-a748-4fb4c4f9f391_20250514T12:13_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling for the provider office to check an additional information about the claim that has been denied. Please note this call will be monitored or recorded for quality and training purposes. Before going on call, can you spell out your name, please?
[AGENT][NEUTRAL] My name is spelled [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] I'm happy to check on a claim, [PII]. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's 02573312.
[AGENT][NEUTRAL] And if I can get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you and what's the date of service?
[CUSTOMER][NEUTRAL] The service is [PII].
[AGENT][NEUTRAL] And the bill amount?
[CUSTOMER][NEUTRAL] Oh wait a minute, it's loading in my system.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you for your patience and the bill amount is $454.48.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And we got the rejection stating that patient is not active for the data service.
[AGENT][NEUTRAL] All right, let's see here.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so it looks like we did receive the claim. The denial was actually that office visits are not covered under the member's policy. Uh, the policy does not provide a benefit for the services that were incurred.
[CUSTOMER][NEUTRAL] So it is non-covered as for the patient's plan.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Can you tell me the mailing address?
[AGENT][NEUTRAL] Appeal mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] And the timely ailing limit?
[AGENT][NEUTRAL] To submit an appeal is within 180 days of the decision.
[CUSTOMER][NEUTRAL] Can you tell me the claim receive date?
[AGENT][NEUTRAL] Claus received [PII].
[AGENT][NEUTRAL] And the claim was processed on [PII].
[CUSTOMER][NEUTRAL] And can you verify me the claim number?
[AGENT][NEUTRAL] Claim number is 359.
[AGENT][NEUTRAL] 3468.
[CUSTOMER][NEUTRAL] Can you tell me the call reference number?
[AGENT][NEUTRAL] Call references my name with my last initial and then today's date.
[CUSTOMER][POSITIVE] Thank you for your assistance. Have a nice day. Bye-bye.
[AGENT][NEUTRAL] You too [PII] bye bye.