AccountId: 011433970860
ContactId: dac02933-6a3d-4573-ba1f-9fb04604b2fd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 695549 ms
Total Talk Time (AGENT): 294974 ms
Total Talk Time (CUSTOMER): 197804 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/dac02933-6a3d-4573-ba1f-9fb04604b2fd_20250212T13:43_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 has been recorded for quality and training purposes. Are you OK with that?
[AGENT][NEUTRAL] That is fine. Could you spell your name for me?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, sure, it would be [PII] [PII]. Also, can you spell out your name for me?
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII], what is your, you're welcome. And what is your callback number, please?
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[CUSTOMER][NEUTRAL] Uh, sure, it would be [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Member policy number would be.
[CUSTOMER][NEUTRAL] 01407226.
[AGENT][NEUTRAL] OK, thank you. And you said that you were wanting to check the status of an appeal that was filed with APL for this number, is this correct? Yes, ma'am, I can check that for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] And providing any information that I provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] Patient name would be [PII], and the date of birth is [PII].
[AGENT][POSITIVE] OK, one moment. Thank you.
[AGENT][NEUTRAL] OK, and again for any information that is provided would be a verification of benefits and not a guarantee of payment. So what is the date of service and total bill amount that you're calling about?
[CUSTOMER][NEUTRAL] Yeah, the date of service would be [PII] and total charge $350 even.
[CUSTOMER][NEUTRAL] Oh sorry, it's $850 even, I guess.
[AGENT][NEUTRAL] And the date of service is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so on this claim, OK, so.
[AGENT][NEUTRAL] This policy, this number was not active for this state of service.
[AGENT][NEUTRAL] This policy termed as of 10-1-2023.
[CUSTOMER][NEUTRAL] One, what was the date?
[AGENT][NEUTRAL] And you, you said your date of service was [PII]? And I don't show a OK. So you said 8 1st you said 350.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Then you said 8:50.
[CUSTOMER][NEUTRAL] Yeah, $350.
[AGENT][NEUTRAL] OK. Is it 3 or 8? Because you've given me both numbers.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I'll just check with $350.
[AGENT][NEUTRAL] OK, so on this policy, the claim number.
[AGENT][NEUTRAL] It's going to be
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm, thank you. It was received on 9-18-2024 and it was processed and denied on 9-23-2024.
[AGENT][NEUTRAL] The claim number is 35083777.
[CUSTOMER][NEUTRAL] 35083777
[AGENT][NEUTRAL] 77. That is correct, and it was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the reason for the denial does state
[AGENT][NEUTRAL] That these services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] And uh when it was denied?
[AGENT][NEUTRAL] Again, you, do you need for me to repeat those dates for you?
[CUSTOMER][NEUTRAL] Yeah, please.
[AGENT][NEUTRAL] Received 9-182024, denied 923 2024.
[CUSTOMER][NEUTRAL] As policy was already termed, right?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefits, Peran, you can print that from our portal using that claim number by going to secured. [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, can you help me with the effective and term date of the policy?
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] The effective
[AGENT][POSITIVE] This policy was effective as of one moment.
[AGENT][NEUTRAL] [PII] term date [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And is there any active policy if the patient has?
[AGENT][NEGATIVE] There is not for that data service, no.
[CUSTOMER][NEUTRAL] OK, sure. Just a moment.
[CUSTOMER][NEUTRAL] I just need to uh confirm that uh there is only one claim number like.
[CUSTOMER][NEUTRAL] The claim has been processed only once, right?
[AGENT][NEUTRAL] It was
[AGENT][NEUTRAL] It was processed initially needing the primary insurance company's explanation of benefits which you should have that claim for if you said that you all filed an appeal, but we don't show that as an appeal we show it as a as another claim receipt, not an appeal.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh yeah, we have actually submitted an EOB.
[AGENT][NEUTRAL] And then that is the one.
[AGENT][NEUTRAL] Correct, but that's not an appeal. We do not have an appeal on file. We received a second claim and the claim, that is the claim number that I provided for you that it was processed and denied.
[CUSTOMER][NEUTRAL] The first claim num the first number was 3,403,170. Is that right?
[AGENT][NEUTRAL] Ah.
[AGENT][NEUTRAL] I can check that one moment.
[AGENT][POSITIVE] That is correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that was denied for primaries EOB. Actually we have submitted primary EOB on [PII].
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] We did not receive that, but we received another claim with all of the information.
[AGENT][NEGATIVE] On the receipt date that I gave you and it was processed and denied because the number was not active for the data service. Services were rendered after coverage terminated.
[CUSTOMER][POSITIVE] OK, sure. No problem. Thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Can you help me with the car reference number?
[AGENT][NEUTRAL] My name in today's date.
[CUSTOMER][NEUTRAL] OK, thank you. If possible, can you help me with the eligibility of the member ID which I have?
[AGENT][NEUTRAL] For this member?
[CUSTOMER][NEUTRAL] For the same member?
[AGENT][NEUTRAL] Yes ma'am, I gave you the eligibility, uh huh, I gave you the policy effective date and term date.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, actually I do have another member ID for the same member. I just need to verify is that active or not.
[AGENT][NEUTRAL] OK, so give me a moment, [PII] and let me it OK, and let me um.
[AGENT][NEUTRAL] Let me complete my portion of this policy, one moment.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][NEUTRAL] OK, and what is your policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number would be 014.
[CUSTOMER][NEUTRAL] 072
[CUSTOMER][NEUTRAL] 26
[AGENT][NEUTRAL] That's the same numbers we just did.
[CUSTOMER][NEUTRAL] M as in Mike.
[CUSTOMER][POSITIVE] Oh sorry sorry for that actually it's 016.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] 280
[AGENT][NEUTRAL] OK, now let's start over. I'm
[CUSTOMER][NEUTRAL] 97
[AGENT][NEUTRAL] OK, I'm sorry, go ahead, start over again, please, with the full number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh sorry?
[AGENT][NEUTRAL] Start with the full policy number. Start from the beginning again.
[CUSTOMER][NEUTRAL] Uh, OK, sure, sure, it would be 01628097.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima 7.
[AGENT][NEUTRAL] So this is for a different patient?
[CUSTOMER][NEUTRAL] It's for the same number.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] No, ma'am. What is your patient's name again and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. date of [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And then, um, and also any information provided on this policy would be a verification of benefits and not a guarantee of payment. This policy is not active. This policy had an effective date of [PII] and a term date of [PII].
[CUSTOMER][POSITIVE] OK, thank you so much. That's it for the day. Thank you so much for your help.
[AGENT][POSITIVE] OK, well, you're welcome. And so again, if that is all I can help with, and thank you for calling APL and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Have a wonderful day bye bye take care.
[AGENT][POSITIVE] Thank you. You too. Bye-bye.