AccountId: 011433970860
ContactId: e88ccc5f-71b7-4f37-a8ee-de179763bb2f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 232539 ms
Total Talk Time (AGENT): 99513 ms
Total Talk Time (CUSTOMER): 88181 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/e88ccc5f-71b7-4f37-a8ee-de179763bb2f_20250307T15:29_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider office and I'm looking for a claim status.
[AGENT][NEUTRAL] OK, we'll verify claim status for you and you say your name is [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, and what is the policy number, please?
[CUSTOMER][NEUTRAL] 02497628 M as in Mike L as in Lima 800.
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] [PII]. Well the amount is $425.
[AGENT][NEUTRAL] And the balance after primary process the claim?
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 223.91.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And while I'm looking up claim information, just to let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII]. And what's the name of the provider's office?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Brick Incorporate.
[AGENT][NEUTRAL] OK, I'm showing that claim process as um DME is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the claim received and processed date?
[AGENT][NEUTRAL] Claim received [PII], processed on [PII].
[CUSTOMER][NEUTRAL] And if you were [PII].
[CUSTOMER][NEUTRAL] OK. So, uh, is there any patient responsibility?
[AGENT][NEUTRAL] We don't give patient responsibility. We can only verify how we process the claim, which was processed as a DME is not covered for the patient's policy.
[CUSTOMER][NEUTRAL] responsibility we can only.
[CUSTOMER][NEUTRAL] OK. So I understand, but uh we received a correspondence letter stating the claim is denied for non-coverage charges, but there is no patient responsibility in that. So if we know that we have in patient trust.
[AGENT][NEUTRAL] It's not gonna have patient responsibility and we cannot give patient responsibility. As I said, we can only verify how the claim was processed, which is not covered.
[CUSTOMER][NEUTRAL] OK. So, what will be the timely filing limit?
[AGENT][NEUTRAL] For what?
[CUSTOMER][NEUTRAL] Appeal
[AGENT][NEUTRAL] Uh, you have up to 180 days from the time the claim was processed to submit an appeal, and you must submit a letter stating the reason for the appeal.
[CUSTOMER][NEUTRAL] Can I get the fax number?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Can I get the claim number?
[AGENT][NEUTRAL] 3561059.
[CUSTOMER][NEUTRAL] 35,610.
[CUSTOMER][POSITIVE] OK. Thank you so much for providing all this information. I'm ready for the reference number for this call.
[AGENT][NEUTRAL] We don't give reference numbers. If you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][POSITIVE] All right. Thank you so much. You have a wonderful day.
[AGENT][POSITIVE] You too. Thanks for calling APL. Have a great day, [PII].
[CUSTOMER][POSITIVE] great
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Mhm.