AccountId: 011433970860
ContactId: c2edd160-fbaa-4d2f-8298-d8a492970930
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 548429 ms
Total Talk Time (AGENT): 121386 ms
Total Talk Time (CUSTOMER): 189163 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/c2edd160-fbaa-4d2f-8298-d8a492970930_20250311T16:54_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL this is.
[CUSTOMER][NEUTRAL] Hi, this is [PII].
[AGENT][NEUTRAL] May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling for a provider to check on additional information about the claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes. May I know your name, please?
[AGENT][NEUTRAL] Yes, my name is [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And [PII], can I get your call back number?
[CUSTOMER][NEUTRAL] [PII] and it's a direct line.
[AGENT][POSITIVE] Thank you so much and what is um the member's name, date of birth and policy number so I can check the claim status for you.
[CUSTOMER][NEUTRAL] The patient, the member ID is 02329132 and the name of the patient is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, and let me look up that policy real quick.
[AGENT][NEUTRAL] OK and then can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Sure, the rate of services [PII]. The amount is $847.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] This is the primary.
[AGENT][NEUTRAL] No, we're the secondary.
[CUSTOMER][NEUTRAL] American Public Life Insurance Company.
[CUSTOMER][NEUTRAL] Am I right?
[AGENT][NEUTRAL] OK, alright, thank you and then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] The name of the facility I'm calling for is Perivvia Medical Group.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, Miss [PII], while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] Yeah, I do have a specific concern, so the. You are on hold.
[CUSTOMER][NEUTRAL] Uh yeah, well you make.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Are you there?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] You had you had a specific concern?
[CUSTOMER][NEUTRAL] Yeah. So the patient encountered for gynecological examination and the physician rendered periodic comprehensive preventive medicine the evaluation.
[CUSTOMER][NEUTRAL] And management and pelvic evaluation and removal, non-biodegradable drug delivery implant to the patient. That in our procedure code 993959945911983. So these three codes are denied. So, may I get any information about these three codes?
[AGENT][NEUTRAL] OK, um, I'll give you uh a reason. Let me look up the claim and I'll be right back.
[CUSTOMER][NEGATIVE] Yeah. You are on hold.
[AGENT][NEUTRAL] [PII], what is the name of the what is the claim number that you have?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So the claim number is
[CUSTOMER][NEUTRAL] 356
[CUSTOMER][NEUTRAL] 421 9.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold again and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me. So looking at the claim, the claim was denied forever because office visits are not covered under the patient's policy.
[CUSTOMER][POSITIVE] Mhm. No problem.
[CUSTOMER][NEUTRAL] OK. Of this are not covered as per the patient policy, am I right?
[AGENT][NEUTRAL] Yeah. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Only one moment.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, yeah, it's an office is it.
[CUSTOMER][NEUTRAL] right.
[CUSTOMER][NEUTRAL] Only one moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, because uh because uh.
[CUSTOMER][NEUTRAL] You know the Torah and this
[CUSTOMER][NEUTRAL] So, for this, you won't pay, am I right?
[AGENT][NEUTRAL] Correct. Office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] on the
[CUSTOMER][NEUTRAL] Mhm mhm. OK. So just for documentation purpose, may I know the correct mailing address?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] That's [PII], [PII], and the zip code is [PII].
[CUSTOMER][NEUTRAL] May I know the timeifying limit?
[AGENT][NEUTRAL] We do not have one.
[CUSTOMER][NEUTRAL] OK, no problem. May I know the mailing address?
[AGENT][NEUTRAL] It's also the same address I gave you.
[CUSTOMER][NEUTRAL] OK. Faifying limit for appeal?
[AGENT][NEUTRAL] 180 days from the date that the claim was initially processed and you'll also need a letter why you want to appeal.
[CUSTOMER][NEUTRAL] Is there any specific forms needed to submit an app?
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] Thank you so much. Only one moment. Yeah, may I know the call reference number?
[AGENT][NEUTRAL] Yes, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you so much. I do have another plan. Are you willing to help me?
[AGENT][NEUTRAL] Yes ma'am, can you give me the member's name, date of birth, and policy number?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] The member ID is U as in Uniform 0165688501.
[AGENT][NEUTRAL] OK, that is not our policy number.
[AGENT][NEUTRAL] That's not APL.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK. OK. No problem. Thank you so much. I thought it's an American specialty. OK, no problem. Thank you so much for your fabulous assistance. Yeah. Bye-bye. Take care.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Bye-bye. You have a wonderful day and thanks for calling APL.