AccountId: 011433970860
ContactId: c8231c63-7ad7-4916-bb58-2240f8f6db86
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 426489 ms
Total Talk Time (AGENT): 145006 ms
Total Talk Time (CUSTOMER): 127873 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/c8231c63-7ad7-4916-bb58-2240f8f6db86_20250129T20:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from the provider's office to check on the claim status.
[AGENT][NEUTRAL] What's your name, ma'am?
[CUSTOMER][NEUTRAL] [PII], spelled like [PII]
[AGENT][NEUTRAL] [PII], OK. And you said you're checking a claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] 023
[CUSTOMER][NEUTRAL] 377.
[CUSTOMER][NEUTRAL] 56
[CUSTOMER][NEUTRAL] M as in Mary.
[CUSTOMER][NEUTRAL] I as in Indiana, H.
[AGENT][NEUTRAL] OK, and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] and it's a direct line.
[AGENT][NEUTRAL] OK, thank you, [PII]. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and so we're checking for claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, we can help you with that information. What's the date of service and total bill?
[CUSTOMER][NEUTRAL] That is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] A the the amount is $6,513.30.
[AGENT][NEUTRAL] OK. 13 cents or 30 cents?
[CUSTOMER][NEUTRAL] 330.
[AGENT][NEUTRAL] OK. OK. Is this a professional fee or a facility charge?
[CUSTOMER][POSITIVE] Professional.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Uh, [PII], I see that the claim was received [PII].
[AGENT][NEUTRAL] Processed [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, there was no payment made, um, on this claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, it says that um this service is not covered when performed in a doctor's office or a clinic. So treatment in a doctor's office is not covered by the patient's policy.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] If they're covered then the services.
[CUSTOMER][NEUTRAL] Performed in doctor's office, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Can I get the mailing address to submit a reconstation for this one?
[AGENT][NEUTRAL] It's the claims mailing address [PII].
[AGENT][NEUTRAL] [PII] in [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the timely filing limit to submit an appeal is up to 180 days, not up to, it's 180 days from the date.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Of denial?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment, please.
[AGENT][NEUTRAL] And that would need to be
[CUSTOMER][NEUTRAL] And once again, can I get the [PII] 2nd please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it. Just just.
[AGENT][NEUTRAL] Did you get the city, state, and zip code?
[CUSTOMER][POSITIVE] Yes, I got that one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can also check your status on our online service center at [PII].
[CUSTOMER][NEUTRAL] I can also
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And uh be sure to put to the attention of appeals when you submit that reconsideration slash appeal.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And for this one is the fax number?
[AGENT][NEUTRAL] 877.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Any other questions I can assist with today, [PII]?
[CUSTOMER][NEUTRAL] Can I get the claim number?
[AGENT][NEUTRAL] 351-6491.
[CUSTOMER][NEUTRAL] And I do have one more data service to check on for the same number. It's the call reference number gonna be the same? Yes, the date of service is [PII]. Total bill amount is $66,513.30.
[AGENT][NEUTRAL] Date of service in charge?
[AGENT][NEUTRAL] Can you repeat the total bill amount again, please?
[CUSTOMER][NEUTRAL] Sure. 6513.30.
[AGENT][NEUTRAL] $6,513.30.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this state of service was denied for the same reason, the claim number?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's 352.
[AGENT][NEUTRAL] 1853.
[CUSTOMER][NEUTRAL] OK, can I get the receipt?
[AGENT][NEUTRAL] And this claim was receipt.
[AGENT][NEUTRAL] Was received [PII], processed [PII].
[CUSTOMER][POSITIVE] Yes, I need that form.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Yes, I got the details. Thank you so much. And can I get the spelling of your name?
[AGENT][NEUTRAL] Mhm. You'll use my name in today's status reference for today's call. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] ONYA first initial last name is [PII] and any other questions, [PII]?
[CUSTOMER][POSITIVE] No, I got the thanks. Thank you.
[AGENT][POSITIVE] You're welcome thanks for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Have a nice day you too take care bye bye.