AccountId: 011433970860
ContactId: d2136051-d9b5-4359-bcd6-e57accde7d2e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 235190 ms
Total Talk Time (AGENT): 86369 ms
Total Talk Time (CUSTOMER): 76826 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/d2136051-d9b5-4359-bcd6-e57accde7d2e_20250623T16:08_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. I'm calling from Riverview Health. Um, actually I need to check claim status for one of the members.
[AGENT][NEUTRAL] OK, I can verify claim status for you and your name is again? You said [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and Miss [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Yes, it is 02212163 ML 8.
[AGENT][NEUTRAL] Thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, and the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] [PII] billed amount was.
[CUSTOMER][NEUTRAL] $201.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] See and the name of the provider's office?
[CUSTOMER][NEUTRAL] Uh, it is, give me one moment.
[CUSTOMER][NEUTRAL] It should be Riverview Medical Group.
[AGENT][NEUTRAL] OK, I show that claim process as office visits are not covered per the policy.
[CUSTOMER][NEUTRAL] Uh, what is the claim number?
[AGENT][NEUTRAL] 342-527-0
[CUSTOMER][NEUTRAL] OK. And it is uh denying as not covered for policy?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Services not covered? OK.
[AGENT][NEUTRAL] It processes office visits are not covered per the policy.
[CUSTOMER][NEUTRAL] OK, what did the claim was received?
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] 2
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh, claim received on [PII], processed on [PII].
[AGENT][NEUTRAL] Uh, [PII], I apologize.
[CUSTOMER][NEUTRAL] OK. Is it possible you can fax me the EOB?
[AGENT][NEUTRAL] Sure. What's your fax number?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, and that's [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and Ms. [PII], is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Yes, what is the timely to submit a reconsideration or an appeal?
[AGENT][NEUTRAL] Uh, to submit appeal, you have up to 180 days from the time the claim was processed to submit an appeal, you must submit a letter stating the reason for the appeal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And then what is the call reference number for today's call?
[AGENT][NEUTRAL] Uh, if you like, you may use my name at today's date.
[CUSTOMER][NEUTRAL] OK, and then good question is, is there a fax number to a fax and appeal?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right, thank you so much that's all I needed.
[AGENT][POSITIVE] You're welcome. Mhm. Thank you for calling APM Ms. [PII]. Have a great day.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Bye. You too.
[AGENT][NEUTRAL] Bye.