AccountId: 011433970860
ContactId: e958fe48-395f-4efc-830e-597f55bd5d45
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 298070 ms
Total Talk Time (AGENT): 89250 ms
Total Talk Time (CUSTOMER): 134501 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/e958fe48-395f-4efc-830e-597f55bd5d45_20250321T18:39_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling for the provider Gym Melton to check on and claim status for [PII]. Please be informed this call has been recorded and monitored for quality and training purposes. Hey, [PII], how are you doing this Friday?
[AGENT][NEUTRAL] Good, [PII]. Can I get the patient's policy number, please?
[CUSTOMER][POSITIVE] Good to hear that.
[CUSTOMER][NEUTRAL] Definitely, sir. The policy number is 018885558.
[AGENT][NEUTRAL] Do you have a good callback number?
[CUSTOMER][NEUTRAL] Definitely, it's [PII] and it's a direct line, no extension, [PII].
[AGENT][NEUTRAL] Thank you, [PII]. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yep, the patient's name is, uh, patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Data of service you said was [PII], is that correct?
[CUSTOMER][NEUTRAL] Uh yeah, [PII], correct.
[AGENT][NEUTRAL] And the build them out.
[CUSTOMER][NEUTRAL] It is $1,993.62. 1993.62.
[CUSTOMER][NEGATIVE] None of them I get up.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It looks like we did receive a claim for this state of service. The claim was received on [PII].
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] Claim was
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][NEUTRAL] OK, sorry to interrupt you.
[AGENT][NEUTRAL] Uh, the claim was denied.
[CUSTOMER][NEUTRAL] On.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] May I know the reason?
[AGENT][NEUTRAL] Services not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] So services are not covered when when performed?
[AGENT][NEUTRAL] In a doctor's office.
[CUSTOMER][NEUTRAL] In a doctor's office or cleaning, right?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is it not covered under the provider's contract or like is it not covered under the payer guidelines like you guys do not cover that?
[AGENT][NEGATIVE] It's not covered under the member's plan.
[CUSTOMER][NEUTRAL] Under the member's plan, OK.
[CUSTOMER][NEUTRAL] May I get the timely filing limit to submit the corrected claim?
[AGENT][NEGATIVE] Uh, no timely filing.
[CUSTOMER][NEUTRAL] OK. There's no time filing for collected claim. No worries. One moment.
[CUSTOMER][NEUTRAL] Is there any time finding for appeal?
[AGENT][NEUTRAL] Uh, for an appeal that must be filed within 180 days of the decision.
[CUSTOMER][NEUTRAL] OK. 100 and what was that again? 180 days?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] From the decision date, OK. May I get that corrected claim mailing address?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That would be [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] One moment. [PII]. The ZIP code is?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect. And um yeah, is it the same address for appeal as well?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] One moment. There is no specific form for appeal, right?
[AGENT][NEUTRAL] No, it just needs to be in writing.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Perfect. May I get the claim number, please?
[AGENT][NEUTRAL] 356.
[AGENT][NEUTRAL] 354 3.
[CUSTOMER][NEUTRAL] 356 35. OK. 3563543, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Call reference number for today's call.
[AGENT][NEUTRAL] My name with my last initial, then today's date. My name again is [PII], last initial is [PII]. Today's date is [PII].
[CUSTOMER][POSITIVE] 225. Perfect. Thank you so much then. That's all I had for the day. Thank you so much for your assistance. I hope you have a great weekend, [PII]. Thank you and bye for now, [PII].
[AGENT][NEUTRAL] You too, [PII]. Bye-bye.