AccountId: 011433970860
ContactId: d1a8ada1-3087-4273-8c8f-e77507888a13
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1153880 ms
Total Talk Time (AGENT): 259155 ms
Total Talk Time (CUSTOMER): 329743 ms
Interruptions: 4
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/d1a8ada1-3087-4273-8c8f-e77507888a13_20250204T17:53_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling for Mobile andheia Associates LLC. Please be informed that this call is being recorded and monitored for quality and training purposes. I'm calling to check on the claim status.
[AGENT][POSITIVE] OK, I can help you with the claim status [PII], can you please give me your callback number just in case our call is disconnected? You're very welcome.
[CUSTOMER][POSITIVE] Yeah, thank you.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello, [PII], can you give me your callback number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure. So, it's going to be [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name?
[CUSTOMER][NEUTRAL] It's a little
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] And what is [PII]'s policy number?
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[CUSTOMER][NEUTRAL] Just a moment, [PII].
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, please take your time.
[CUSTOMER][POSITIVE] Yeah thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, 30, so it's 02.
[CUSTOMER][NEUTRAL] Yeah. Now, can you tell?
[CUSTOMER][NEUTRAL] So the policy number is 023041177 M as in Mike L as in Lima H.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me pull in that policy real quick for us.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, and let me make sure I've got it correct, 02.
[AGENT][NEUTRAL] 3041177 ML 8.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that's not pulling in for me.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You can't find the status of the client?
[AGENT][NEUTRAL] I've
[AGENT][NEUTRAL] Ma'am, what did you just say?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, you said something before I couldn't hear that. Could you please repeat that?
[AGENT][NEUTRAL] Yes, um, I wasn't able to pull in that policy number. Can you repeat it one more time for me? It's got too many digits.
[CUSTOMER][NEUTRAL] Yeah, sure. So it's 023 041177.
[CUSTOMER][NEUTRAL] M L H.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me try.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEGATIVE] Yeah, that's still too many.
[AGENT][NEUTRAL] 41
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] ones that drop one of your one.
[CUSTOMER][NEUTRAL] Hey you
[AGENT][NEUTRAL] And it'll be the correct policy number 2304.
[CUSTOMER][NEGATIVE] Uh, sorry for the interruption. Your voice is breaking.
[CUSTOMER][POSITIVE] Sorry, your voice is breaking actually sorry for the interruption.
[AGENT][NEUTRAL] Sorry
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, I can't hear you what you are telling you.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] 23041.
[CUSTOMER][NEUTRAL] Just a moment, T. Actually, your voice is breaking, so I can't hear what you're telling.
[AGENT][NEUTRAL] Can you hear me now?
[CUSTOMER][NEUTRAL] Yeah, now I can hear you.
[AGENT][NEUTRAL] Hello? OK, good. OK, so that, that policy number is 2304.
[CUSTOMER][NEUTRAL] Yeah, I can hear you.
[AGENT][NEUTRAL] 177. No, no, no, no, no, no, no, no. I found it. I found it. The policy number you have, you need to take out a 1. There's too many ones. It's only one number one.
[CUSTOMER][NEUTRAL] No, it's 023.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, could you please uh tell that for me?
[AGENT][NEUTRAL] Yes, it's 230-417-77.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, you, so.
[AGENT][NEUTRAL] OK, and what is the data service?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So, it's [PII].
[AGENT][NEUTRAL] OK thank you and what is the um.
[AGENT][NEUTRAL] Large amount, please.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] A scenario.
[CUSTOMER][NEUTRAL] Uh, so.
[CUSTOMER][NEUTRAL] The bill amount is
[CUSTOMER][NEUTRAL] $1,437 even.
[CUSTOMER][NEUTRAL] You know?
[AGENT][NEUTRAL] OK, and then what is the charge after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Just.
[CUSTOMER][NEUTRAL] Yeah, just a moment to.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So it's $295.77.
[AGENT][NEUTRAL] OK, thank you and then you said you were calling from Mobile Associates LLC?
[CUSTOMER][NEUTRAL] Yeah, mobile Anetheia Associates LLC.
[AGENT][POSITIVE] OK, thank you so much, Ms. [PII] I'm gonna put you on a brief hold while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] Yes. You are on hold.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Oh thank you [PII] for holding for me so I did find the claim.
[AGENT][NEUTRAL] The claim number is, the claim number is 35095997.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] The claim, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] The claim was received on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim was denied because the services are not covered if performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, just a moment, [PII]. May I place the call on hold for 2 minutes while I verify the records for you, [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yeah, thank you so much. Just I'll back.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Hello [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thanks for being on hold. I appreciate your patience. Yeah. Yeah. May I know the date, uh, sorry, could you please repeat that for me?
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, thank you. So may I know the denied date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Thank you, [PII]. May I know the CPT or diagnosis is not covered?
[AGENT][NEUTRAL] It's a non-covered if it's performed in a doctor's office, the clinic.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh, may I know, it is non-covered under the payers guidelines or patients plan or provider contract?
[AGENT][NEUTRAL] Yes, a patient's plan a provider contract.
[AGENT][NEUTRAL] For the patient's policy.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] May I know the mode of submission?
[CUSTOMER][NEUTRAL] For the correct claim or appeal.
[AGENT][NEUTRAL] Uh, if you want to appeal, it has to be done within 180 days from the date the claim was initially processed and you'll need a letter Y.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] May I know the appeals mailing address?
[AGENT][NEUTRAL] Yes, it is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you, [PII].
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So do you need any supporting documents?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Mm, no, you could if you if you appeal the claim you'll need a letter why you're appealing the claim.
[AGENT][NEUTRAL] And it has to be done within 180 days.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] So we will need a letter Y.
[CUSTOMER][POSITIVE] OK, thank you. Do you
[CUSTOMER][NEUTRAL] OK, thank you, [PII]. Do, do you require a copy of denied UOB when the resubmit a corrected claim or when we decide to do an appeal?
[AGENT][NEUTRAL] Uh, you'll need the claim number and a letter why you want to appeal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] So, could you please mail or fax the copy of denied EOB?
[AGENT][NEUTRAL] Yes, can I get your fax number?
[CUSTOMER][NEUTRAL] Yeah, sure. One moment.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] So it's [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on hold while I fax that over to you. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK [PII], I've got that fax on its way to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, sure, thank you.
[CUSTOMER][NEUTRAL] So, may I know the claim number?
[AGENT][NEUTRAL] Yes, the claim number is 35095997.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, thank you. So could you please help me with the call reference?
[AGENT][NEUTRAL] Yes, you can use my name. It is [PII] and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, sure. Thank you for your assistance. Have a great day.
[AGENT][POSITIVE] You too, [PII] you have a blessed one. Thanks for calling APL.
[CUSTOMER][NEUTRAL] this
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][NEUTRAL] Bye bye.