AccountId: 011433970860
ContactId: cd54eef2-d95b-43fa-9000-cd6843284af5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 442000 ms
Total Talk Time (AGENT): 176636 ms
Total Talk Time (CUSTOMER): 87566 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/cd54eef2-d95b-43fa-9000-cd6843284af5_20250128T18:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], this is [PII] calling from provider's office to check up on an appeal status. Also, this call is being recorded for quality and training purposes. Are you OK with that?
[AGENT][NEUTRAL] Yeah, and I can check on that appeal. Um, can I get a good call back number from you first, [PII], in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it would be [PII].
[AGENT][NEUTRAL] All right, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, I do have.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It would be 016.
[CUSTOMER][NEUTRAL] 59803 M as in Mike L as in Lima 8. Actually, I do have claim number as well.
[AGENT][POSITIVE] Oh that would be great, yes please.
[AGENT][NEUTRAL] Uh, I'm ready for that claim number when you are.
[CUSTOMER][NEUTRAL] Yeah, uh 349.
[CUSTOMER][NEUTRAL] 8956.
[AGENT][NEUTRAL] OK, thank you and uh what was the name and date of birth for the member?
[CUSTOMER][NEUTRAL] It's it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for that. And when was this appeal sent to us?
[CUSTOMER][NEUTRAL] It was on [PII] through fax.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, bear with me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, um, the claim number that you gave me, [PII], um, was it for date of service [PII]?
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, so I've got this claim falling under a different policy number.
[AGENT][NEUTRAL] And the member has a different last name.
[CUSTOMER][NEUTRAL] Different last name.
[AGENT][NEUTRAL] Yes, um.
[AGENT][NEUTRAL] So give me just a moment. The policy number you gave me was an older one, and her last name was that there, so that's fine. Um, we've got, uh, Barroso, um, just a moment. Let me check this, uh, updated policy number.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, I'm sorry, [PII], I am not showing that we received an appeal.
[CUSTOMER][NEUTRAL] Actually this claim was denied for primary GOB and we have submitted primary GOB, yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And that was so it wasn't
[AGENT][NEUTRAL] You just sent us the primary EOB.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] OK, so I am showing that we've received claim information um that was [PII], um, and that is, uh, it's Pembroke Pink Imaging.
[AGENT][NEUTRAL] Is that correct? OK, um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] All right, but it is just stating the same. Let me see.
[AGENT][NEUTRAL] That we need the EOB, so you're saying that what you submitted was the EOB correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So that might need to be resubmitted to us, [PII], um, but if you'll give me one moment, I will double check.
[AGENT][NEUTRAL] Let's see if I can see what has been sent in um if not I can reach out to our claims specialist so that they could take a look but give me just a moment let me see what I can see.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][POSITIVE] Sure, no problem. Take your time. That's fine, yeah.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright, um, yeah, if it's all right with you, [PII], I'm gonna put you on a brief hold and reach out to our claims specialist. I'll get right back with you OK?
[CUSTOMER][POSITIVE] OK sure thank you.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] This is funny.
[AGENT][NEUTRAL] Who is this? I'm sorry?
[CUSTOMER][NEUTRAL] This is money
[AGENT][NEUTRAL] Hi [PII], this is [PII] on the care team. How's it going today?
[CUSTOMER][POSITIVE] Great how are you?
[AGENT][NEUTRAL] Doing all right thank you. I've got a provider on the line uh calling regarding a claim um the original claim stated we needed the primary EOB. She said she did submit that uh the date that she did I see that and according to the claim it's just saying the same thing that we need the primary EOB, uh, so we're just kind of double checking to see if what they submitted was sufficient.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I tried looking at what they submitted, but I'm gonna be honest, I'm not sure what I'm looking at. It was like I see Aetna on there but.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, OK, the policy number is 2497505.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it is for part 2. I've got that claim number.
[CUSTOMER][NEUTRAL] OK, 42 and the claim number?
[AGENT][NEUTRAL] It is 353-354-2.
[CUSTOMER][NEUTRAL] And then who am I speaking with?
[AGENT][NEUTRAL] Her name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][POSITIVE] OK thank you I appreciate it.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right, bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.