AccountId: 011433970860
ContactId: efd19e04-5cb7-4b32-a067-713e9bd9f370
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 368480 ms
Total Talk Time (AGENT): 110852 ms
Total Talk Time (CUSTOMER): 91685 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/efd19e04-5cb7-4b32-a067-713e9bd9f370_20250305T19:52_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling fromow Office to Jaana claims lineal reason.
[AGENT][NEUTRAL] OK, well, I can verify claim status for you and you say your name is [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] So that is 021562223.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Could you please spell your name for me?
[AGENT][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] And [PII], what is the callback number in case the call drops?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Callback number [PII].
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] There are service for this claim is [PII] and charge on $500 even.
[AGENT][NEUTRAL] OK, and you said [PII], correct?
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And you're calling from?
[CUSTOMER][NEUTRAL] Calling from Duke Health Integrated Practice.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And I apologize. What was the name of the provider's office you're calling from?
[CUSTOMER][NEUTRAL] Duke Health Integrated Practice.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK let's see.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so this claim.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] Showing the claim process is to count policy maximum of 4 visits have been met for the year.
[CUSTOMER][NEUTRAL] So it is the maximum.
[CUSTOMER][NEUTRAL] Number of hours, right?
[AGENT][NEUTRAL] Number of visits have been met for the year.
[CUSTOMER][NEUTRAL] Uh, OK, is the number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, yeah, what is allowed?
[CUSTOMER][NEUTRAL] All units?
[AGENT][NEUTRAL] Uh, they have had up to 4 visits per year.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, but this is the first time we have billing this procedure code for this patient, actually.
[AGENT][NEUTRAL] Well, it could be from other providers, which I'm not going to give you that information, but they've met their 4 visits for the year.
[AGENT][NEUTRAL] Whether it's from just this, it's not per provider, it's.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Per visit.
[CUSTOMER][NEUTRAL] So, you don't provide the other information, right?
[AGENT][NEUTRAL] No, we're not, we don't give that other information from any other provider.
[CUSTOMER][POSITIVE] Thank you very much for this. May I get the dinner date of this claim?
[AGENT][NEUTRAL] Uh, the claim process on, give me a moment.
[AGENT][NEUTRAL] Uh, [PII] of this year.
[CUSTOMER][NEUTRAL] The [PII]. Thank you. May I get the claim number?
[AGENT][NEUTRAL] 356-046-3.
[CUSTOMER][NEUTRAL] OK. May I get the apple name?
[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] OK. I also need letters stating the reason, right?
[AGENT][NEUTRAL] Yes, you must submit a letter stating the reason for the appeal.
[CUSTOMER][POSITIVE] Thank you very much for this one.
[CUSTOMER][POSITIVE] And uh yeah, thank you so much for this one. And may I get a
[CUSTOMER][NEUTRAL] Call reference number.
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name in today's date.
[CUSTOMER][POSITIVE] Thank you, [PII]. Have a great day.
[AGENT][POSITIVE] Mhm. You're welcome. Thanks for calling APL. Bye.
[CUSTOMER][NEUTRAL] Bye now.
[CUSTOMER][NEUTRAL] So