AccountId: 011433970860
ContactId: eea91017-c9df-4d93-8907-50029ebfb408
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 446950 ms
Total Talk Time (AGENT): 83730 ms
Total Talk Time (CUSTOMER): 68775 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=-1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/eea91017-c9df-4d93-8907-50029ebfb408_20250605T14:19_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Oh hey, my name is [PII]. I'm looking for a payment status for a claim.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status or appeal status, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] OK. It's [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It's 024495998.
[AGENT][NEUTRAL] May I have the name of the facility you're calling from for my notes?
[CUSTOMER][NEUTRAL] Saint Mary's, Sacred Heart.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] OK. So the member [PII], date of birth, [PII].
[AGENT][NEUTRAL] Thank you. May I have the date of service the amount of the claim?
[CUSTOMER][NEUTRAL] Sure. It's on [PII]. Total charge $1,147.
[AGENT][NEUTRAL] OK, and you say you're looking for the appeal status?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, let me see if I can find.
[CUSTOMER][NEUTRAL] Sir, um, the pillow Saint John.
[AGENT][NEUTRAL] OK, what date?
[CUSTOMER][NEUTRAL] Yeah, it was sent on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It uh it is sent through fax.
[AGENT][NEUTRAL] OK. Let me see if I can find it. Uh, do you mind holding for me?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me Mr. [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so I was able to pull the appeal. Um, it looks like it was received on [PII] and processed on [PII], and it was determined that the claim was processed correctly in accordance with the policy contract.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so can we do like a 3rd level appeal? So this was a 2nd level appeal, right? So can we do like another one? Are we like eligible?
[AGENT][NEUTRAL] You can always send an appeal.
[AGENT][NEUTRAL] Mr. [PII].
[CUSTOMER][NEUTRAL] Oh yeah, I'm sorry. Um, so, uh, like, what's the timely filing for sending another pill?
[AGENT][NEUTRAL] The only fi, timely filing limit we have is 180 days from the decision date to submit any appeal. That's the only timely filing limits we have on their appeals.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So we can send that bill like again to the same fax number, right? [PII]?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] OK, thank you. Uh, that's all for now. So can I reference what is it called?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's state if you will.
[CUSTOMER][POSITIVE] Yeah, thank you so much. Bye.
[AGENT][POSITIVE] You're welcome. Thank you for calling EPL. Have a good day, Mr. [PII].
[CUSTOMER][NEUTRAL] You too.