AccountId: 011433970860
ContactId: cd31f426-7592-4a03-a0ca-8901c93bd560
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 552880 ms
Total Talk Time (AGENT): 199549 ms
Total Talk Time (CUSTOMER): 141567 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/cd31f426-7592-4a03-a0ca-8901c93bd560_20250123T14:15_UTC.wav
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[AGENT][POSITIVE] Morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to get an appeal status.
[AGENT][NEUTRAL] I can help you with that, [PII]. What is the callback number?
[CUSTOMER][NEUTRAL] [PII]. And my extension is [PII].
[AGENT][NEUTRAL] Thank you, [PII], and what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] ID number is 02276562.
[AGENT][NEUTRAL] 02276562
[CUSTOMER][NEUTRAL] 02276562, yeah.
[AGENT][NEUTRAL] What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is?
[CUSTOMER][NEUTRAL] [PII], and the uh last name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And what is the data service, please?
[CUSTOMER][NEUTRAL] Yeah, sure. Service date is on [PII] and the total bill amount is for $349.28.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] For [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you know when that appeal was submitted?
[CUSTOMER][NEUTRAL] Sure. Uh,
[CUSTOMER][NEUTRAL] A bill has been submitted on.
[CUSTOMER][NEUTRAL] [PII] through the mail.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm checking her medical policy because I, the policy number you gave me is for accident.
[AGENT][NEUTRAL] Benefits
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] So I'm checking her medical policy to see if it could possibly be on that and what was the total bill amount again [PII]?
[CUSTOMER][NEUTRAL] Yeah, sure. It's $349.28.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] It looks like I do see that claim on her medical policy. Let me check that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the provider name?
[CUSTOMER][NEUTRAL] Mm, yeah, provider's name is [PII].
[AGENT][NEUTRAL] With what group?
[CUSTOMER][NEUTRAL] Uh, it's Park View Physician Group.
[AGENT][NEUTRAL] OK, thank you. All right, if you just give me just one moment, I'm just checking on a couple of things for you.
[CUSTOMER][POSITIVE] Sure, sure. Take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEGATIVE] Now I do see that we received this claim, it looks like 3 different times.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the last claim that we received for that data service and that facility was on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But that claim was denied as a duplicate. I do not see an appeal on file for that data service.
[CUSTOMER][NEUTRAL] OK. Whether the
[CUSTOMER][NEUTRAL] Mailing address is [PII].
[AGENT][NEUTRAL] OK, let me give you the correct address for an appeal.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The correct address for an appeal is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII], we will need a formal appeal letter stating the reason that you are appealing the claim decision.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh do you have the fax number?
[AGENT][NEUTRAL] You can fax that also to our claims department at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Thank you. And uh may I know what's the uh last processing date for this claim?
[AGENT][NEUTRAL] The claim was last processed on [PII] and that was denied as a duplicate.
[CUSTOMER][NEUTRAL] June
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how, and the appeal timefi limit is?
[AGENT][NEUTRAL] 180 days from the original claim denial, that original claim denied.
[CUSTOMER][NEUTRAL] No, it's already crossed.
[AGENT][NEUTRAL] Yeah. The original claim denied on, let me get that.
[AGENT][NEUTRAL] Original claim denied on 10-8-24.
[CUSTOMER][NEUTRAL] 10, 8 of 200.
[AGENT][POSITIVE] 24. That's correct.
[CUSTOMER][NEUTRAL] Just give me one minute.
[AGENT][NEUTRAL] And I will need to give you the correct policy number as well.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][POSITIVE] Thank you so much for holding.
[AGENT][POSITIVE] Mhm. My pleasure.
[CUSTOMER][POSITIVE] Thank you so much for the information. And if you don't mind, can you spell your name?
[AGENT][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And can I give you the correct policy number to submit that under?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] The correct policy number is 227.
[AGENT][NEUTRAL] 656 1.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's 227-6561.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And uh do you have the effective and term dish?
[AGENT][NEUTRAL] Yeah, the effective date on the policy is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the policy termed on 7-28-2024.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And it's been a pleasure to assist you with that claim information. Anything else I can help you with?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] No, no, no. Thank you so much for your information. Uh, are there any call reference or your name and today's date is the call reference number?
[AGENT][NEUTRAL] It's going, yeah, it's going to be my name in today's date, and I spell my name [PII]. Anything else I can help you with?
[CUSTOMER][NEUTRAL] I got it.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][POSITIVE] No, thank you so much. Take care. Bye.
[AGENT][POSITIVE] You take care as well. It's a pleasure to assist you. You have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. Bye.
[AGENT][NEUTRAL] Bye-bye.