AccountId: 011433970860
ContactId: f1349572-ecec-4027-bbb3-16419be8b48d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 342670 ms
Total Talk Time (AGENT): 124171 ms
Total Talk Time (CUSTOMER): 126635 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/f1349572-ecec-4027-bbb3-16419be8b48d_20250624T18:14_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I'm sorry, I didn't get your name. Could you please repeat it again.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] I guess you're on mute.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] [PII], OK. Hello, [PII]. My name is [PII].
[CUSTOMER][NEUTRAL] And my last name initial will be [PII] and I'm calling from the provider's office regarding the claim status.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with that. Can I have a callback number for you?
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah, sure, sir. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], what's the policy number of the member that you're calling to check the status of a claim for?
[CUSTOMER][NEUTRAL] Yeah, it is 021.
[CUSTOMER][NEUTRAL] 189
[CUSTOMER][NEUTRAL] 83 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] So is that 2118983?
[CUSTOMER][NEUTRAL] Yeah, it's 02118983 ML 8.
[AGENT][NEUTRAL] Could you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] And his date of birth will be [PII].
[AGENT][NEUTRAL] Thank you. What is the date of service that you're calling to check the status of a claim for [PII]?
[CUSTOMER][NEUTRAL] The rate of service will be.
[CUSTOMER][NEUTRAL] [PII] with the bill amount of $436 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEGATIVE] This claim was received [PII]. It was processed [PII]. My, there was no payment on this claim, and the reason why there was no payment is because the policy does not offer benefits for services received in the office.
[CUSTOMER][NEUTRAL] I'm sorry. Patient's policy.
[AGENT][NEGATIVE] Does not offer benefits services received in the office.
[CUSTOMER][NEUTRAL] Could you please repeat it again?
[CUSTOMER][NEUTRAL] OK, does not.
[CUSTOMER][POSITIVE] Of benefits.
[CUSTOMER][NEUTRAL] For services received in office.
[CUSTOMER][NEUTRAL] So, it is patients liability, right?
[AGENT][NEUTRAL] Because we are not a primary insurance company, I can't verify that information. I can only verify that there was not a payment made for the claim that was submitted due to the benefits not being covered services not being covered under the policy.
[CUSTOMER][NEUTRAL] OK. It is under the patient's policy right now uncovered and so the balance will be patient's liability.
[AGENT][NEUTRAL] I can't tell you that I can only verify that we didn't make a payment on your claim that you submitted.
[CUSTOMER][NEUTRAL] OK. Claim was received on [PII] and denied on [PII], right?
[AGENT][NEUTRAL] Yes, that is correct. Would you like the claim number?
[CUSTOMER][NEUTRAL] Yeah, what's the claim number?
[AGENT][NEUTRAL] The claim number is 3605239.
[AGENT][NEUTRAL] That's 3605239.
[CUSTOMER][NEUTRAL] OK, so what has to be done on the claim for it to get processed? Can we submit an appeal or the corrected claim will be signed? So what has to be done?
[AGENT][NEUTRAL] Um, no, the benefits are not covered under the policy, so there won't be any payments covered for the services. However, you can submit an appeal and you can send it to the same bill mailing address as you will send a claim, and there is no timely filing.
[CUSTOMER][NEGATIVE] No TFL to submit an a page.
[CUSTOMER][NEUTRAL] Is there any fax to submit an appeal or only the mailing address?
[AGENT][NEUTRAL] Do we have a fax number? Would you like the fax number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, what's the fax number?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 365942318773659423.
[CUSTOMER][NEUTRAL] When
[CUSTOMER][NEUTRAL] [PII] 3.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Claim received on deny that this policy does not go you know.
[CUSTOMER][NEUTRAL] What is the correct claim timely filing for this?
[AGENT][NEUTRAL] Is there anything else that I can?
[AGENT][NEGATIVE] There is no timely filing.
[CUSTOMER][NEUTRAL] OK, no, no is the table for the 2 and the mailing address and the pay ID are same right.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] What's the reference for this call [PII]?
[AGENT][NEUTRAL] We don't provide reference numbers you can use my name in today's date as a reference. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] No. Could you please spell your name?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Would you like for me to provide you with today's date as well?
[CUSTOMER][POSITIVE] Done. Thank you, [PII]. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] No, [PII]. Thank you.
[AGENT][POSITIVE] Thanks for calling APL. Have a good day, [PII]. Goodbye.
[CUSTOMER][POSITIVE] Have a great day. Bye-bye.