AccountId: 011433970860
ContactId: e58938bd-0fa6-42e4-9bd9-9923e685d4da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 391640 ms
Total Talk Time (AGENT): 140913 ms
Total Talk Time (CUSTOMER): 207920 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/e58938bd-0fa6-42e4-9bd9-9923e685d4da_20250207T19:47_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling for provider ID to check for and claim status. Please inform this call is recorded, monitored for quality and training purposes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, I can assist you with claims. And you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And where are you calling from, Ms. [PII]?
[CUSTOMER][NEUTRAL] The facility is BHS Physicians Network.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and may I have a callback number just in case we get disconnected, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes, that is [PII]. It's a direct line.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have the name and date of birth of the pay well, may I have the policy number? I'm sorry.
[CUSTOMER][NEUTRAL] Sure. That is 02440462.
[AGENT][NEUTRAL] OK. And may I have the name and date of birth of the patient, Ms. [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, that is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes, it is for [PII] and the total bill amount is $735 even.
[CUSTOMER][NEUTRAL] Oh my.
[AGENT][NEUTRAL] OK, [PII] $735 evening, correct?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, let me pull this ELB and for future, you can check claim status online through our website at [PII] and that's just optional and it's gonna be a minute. I'm waiting on the explanation of benefits to pull up, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right. It looks like we processed the claim on [PII].
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the claim was denied. The reason for this denial is outpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] And the
[CUSTOMER][NEUTRAL] So, uh, is the service is exceeded in terms of visit?
[AGENT][POSITIVE] In value, um, dollar value.
[CUSTOMER][POSITIVE] OK, dollar value.
[CUSTOMER][POSITIVE] Thank you so much for that. And may I also get the receipt date of the claim?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for that. And could you also help me to know what are the allowed dollar amount for the services?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, let me get the calendar year maximum, one moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That's.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] It's gonna be one more minute.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] No issues. Take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment, just a verification of coverage. Calendar year maximum is 2550.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 2550. OK.
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][NEUTRAL] And when was the last service bill? Do you have any information?
[AGENT][NEUTRAL] We cannot release that information because that's general for any provider so we can only give you information about your claim.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Uh, can I also get the mailing address to submit the appeal?
[CUSTOMER][NEUTRAL] And also.
[AGENT][NEUTRAL] OK, the address is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]. The zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and can we use the same address for uh corrected claim as well? All right. And what is the time you're filing for appeal?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] For an appeal, you have 180 days from the decision date to submit an appeal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is there any specific form used while submitting the appeal?
[AGENT][NEUTRAL] No, it's just a letter appealing the decision.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and do we need to attach the you be along with that?
[CUSTOMER][NEUTRAL] OK so I will member in that.
[AGENT][NEUTRAL] You don't have to, it's up to your discretion.
[CUSTOMER][NEUTRAL] OK. Could you also help me with the family filing to submit a corrected claim?
[AGENT][NEUTRAL] There's no timely filing limits for corrected or claims. It's only for appeals. It's 180 days from the appeal.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] OK. Thank you so much for that. I'm ready for the call reference.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's state if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] No, that's all for the day. Thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.