AccountId: 011433970860
ContactId: edaff795-14dc-49fe-abf0-1b0e8e516a3c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 306750 ms
Total Talk Time (AGENT): 131183 ms
Total Talk Time (CUSTOMER): 95150 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/edaff795-14dc-49fe-abf0-1b0e8e516a3c_20250613T17:44_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] this is how may I assist you? Hi, this is [PII]. I'm calling for provider to check on additional information about a claim that has been denied. Please know this call will be monitored and recorded for quality and training purposes. Could you please spell out your name please for me?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Sure. My name is [PII]. That's [PII]. M is [PII], may I have a callback number just in case we get disconnected? You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII] is a direct line. There is no extension.
[AGENT][NEUTRAL] Thank you. May I have the patient's policy number?
[CUSTOMER][NEUTRAL] 023-393-82 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] That will be
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] with the amount of $80 even.
[AGENT][NEUTRAL] OK, and may I have the name of the facility you're calling from for my notes?
[CUSTOMER][NEUTRAL] That is David M. Steam and M D P A.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment, let me pull all this CIP and see if this is your claim. And for future you can check claim status online through our website at [PII], and that's just optional.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The $80 is the remaining balance or is that the total charge?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Let me take a look. One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Total bill charge is $463.12.
[AGENT][NEUTRAL] OK, alright, um, yeah, it is bear with me.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] 5
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For
[AGENT][NEUTRAL] So it looks like we processed the claim on [PII] and we send a benefit amount of $100 for the code 93,000 code 99205 was denied.
[AGENT][NEUTRAL] And the denial reason for that one is, let's see, office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Policy means the payer or provider?
[AGENT][NEUTRAL] Office visits are not covered by the policy members plan.
[CUSTOMER][NEUTRAL] As the patient
[CUSTOMER][NEUTRAL] OK, got it. And then you got, uh, this one is coordinate on, uh, [PII], right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, and then when did you receive this claim?
[AGENT][NEUTRAL] OK, let me see when it was received. That's not on the EOB, so bear with me just a minute. Let me get that information.
[AGENT][NEUTRAL] Um, let's see 1 it was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much and then.
[AGENT][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK, and then may I know the mailing address for this one?
[AGENT][NEUTRAL] OK, you have 180 days for any appeal submission. The address is [PII]. The zip code is [PII].
[CUSTOMER][NEUTRAL] Can an attention to?
[AGENT][NEUTRAL] Uh, appeals department.
[CUSTOMER][NEUTRAL] Is there any specific for me to be attached or none?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, got it. May I know the call reference number of this call?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][POSITIVE] OK, thank you. OK, thank you for providing information and assisting me. Have a great day. Enjoy the rest of your day and then happy week.
[AGENT][POSITIVE] You as well, Miss [PII], and thank you for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] Mhm.