AccountId: 011433970860
ContactId: f10da89c-de20-4b45-a28a-d89c405e6a34
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 366799 ms
Total Talk Time (AGENT): 76770 ms
Total Talk Time (CUSTOMER): 125793 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/f10da89c-de20-4b45-a28a-d89c405e6a34_20250401T14:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, hi, this is [PII]. My initial is [PII], calling for Palm Beach Orthopedic Institute PA. I verified the you this call is made for additional information about the denial. Please be informed the call is being recorded and monitored for quality and training purposes.
[AGENT][POSITIVE] All right, I'm happy to help today, [PII]. Do we have the patient's policy number?
[CUSTOMER][NEUTRAL] Policy number, let me just check.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Which means member ID, right? It's 1451.
[CUSTOMER][NEUTRAL] 720 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] OK. Give me one moment.
[AGENT][NEUTRAL] And do you have a good call back number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] it's a direct line.
[AGENT][NEUTRAL] Thank you. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and then what is the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then build them out.
[CUSTOMER][NEUTRAL] But the amount is.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] $2,476.50.
[AGENT][NEUTRAL] OK, one moment, let me take a look here.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] All right, so it looks like we did receive this claim, uh, claim was received on [PII]. Uh, claim was denied. Office visits are not covered under the member's policy, and it looks like services were not covered in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Oh, for this postal code [PII] and the postal code [PII]. Is it?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, which means, uh, saying that the service is not covered under the provider's contract.
[AGENT][NEUTRAL] Under the patient's plan, it's not covered.
[CUSTOMER][NEUTRAL] Under the patient's plan. OK, OK, OK. OK, just a moment. Let me just double check it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] One moment, just verifying the email.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm just verifying the Carter claims mailing address is [PII]. OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK, so, uh, may I know when I will receive the claim it was received on March?
[AGENT][NEUTRAL] Claim was received on [PII].
[CUSTOMER][NEUTRAL] OK, and it was the United since it was non-covered service under the patients benefit plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, got it. And I please get the the uh verify the time of filing with you it is 180 days from the date of service, right?
[AGENT][NEUTRAL] For an appeal, that is correct.
[CUSTOMER][NEUTRAL] OK, 180.
[CUSTOMER][NEUTRAL] OK, and may I please get the reference number for this one.
[AGENT][NEUTRAL] Call reference uh is my name with my last initials and today's date. My name is [PII], that's [PII]
[AGENT][NEUTRAL] My last initial is [PII].
[CUSTOMER][NEUTRAL] OK, and today's days for [PII].
[AGENT][POSITIVE] Correct. Yup.
[AGENT][NEUTRAL] Is there anything else, [PII]?
[CUSTOMER][POSITIVE] OK, [PII], got it. So, mm, no, that's all for today. Thank you so much for um on a very good day. Thank you.
[AGENT][NEUTRAL] You too bye bye.