AccountId: 011433970860
ContactId: f975c0bf-d014-4ddc-a288-40e26fd76450
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 537599 ms
Total Talk Time (AGENT): 225715 ms
Total Talk Time (CUSTOMER): 117592 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/f975c0bf-d014-4ddc-a288-40e26fd76450_20250107T14:01_UTC.wav
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[AGENT][POSITIVE] Morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, can you hear me?
[AGENT][NEUTRAL] I can hear you.
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm from the branch office. Can I get your name?
[AGENT][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And [PII], what is a good callback number, please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Thank you. And [PII], what is the policy number for the patient?
[CUSTOMER][NEUTRAL] It's just a second.
[CUSTOMER][NEUTRAL] The policy number, that is
[CUSTOMER][NEUTRAL] 02173249.
[AGENT][NEUTRAL] Thank you, [PII]. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] for the date of birth of [PII].
[AGENT][NEUTRAL] And what was the first name?
[CUSTOMER][NEUTRAL] First name [PII].
[AGENT][NEUTRAL] All right, thank you. And [PII], how can I help you with Mr. [PII]'s policy or Miss [PII]'s?
[CUSTOMER][NEUTRAL] OK, so I was checking on the claim status for the date of service.
[CUSTOMER][NEUTRAL] [PII], build the amount of
[CUSTOMER][NEUTRAL] $552 even?
[AGENT][NEUTRAL] And you said [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thank you. What is the facility name?
[CUSTOMER][NEUTRAL] It's when you can institute.
[AGENT][NEUTRAL] And what was the total bill amount again, please?
[CUSTOMER][NEUTRAL] $542 even.
[AGENT][POSITIVE] All right, thank you, and it would be my pleasure to help you with that claim status.
[AGENT][NEUTRAL] [PII], I'm showing that we did receive that claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEGATIVE] And it was denied as services are not covered when performed in a doctor's office.
[CUSTOMER][NEUTRAL] And when was the same date?
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] And claim denied as.
[CUSTOMER][NEUTRAL] So, this is not end in doctor's office.
[AGENT][NEUTRAL] Not covered when performed in a doctor's office. That is correct.
[CUSTOMER][NEUTRAL] And can number?
[AGENT][NEUTRAL] The claim number 353.
[AGENT][NEUTRAL] 8, I'm sorry, 353-584-3.
[CUSTOMER][NEUTRAL] 353-5843, right?
[AGENT][POSITIVE] Yes, sir, that is correct.
[CUSTOMER][NEUTRAL] And so can you submit a medical records or do you want us to submit a claim or something else changes can be made on the claim?
[AGENT][NEGATIVE] It's just not covered due to the place of service.
[AGENT][NEGATIVE] It's a place of service is not covered.
[CUSTOMER][NEUTRAL] So we can change and.
[CUSTOMER][POSITIVE] And we can take the place of service and we can rebuild the credit limit, right?
[AGENT][NEGATIVE] I cannot tell you to change the place of service. If it was performed in an office, it's not going to be covered.
[AGENT][NEUTRAL] And that's per the patient's policy.
[CUSTOMER][POSITIVE] So it will be this will be the right.
[AGENT][NEUTRAL] Can you repeat that, please?
[CUSTOMER][NEUTRAL] So this the remaining balance will be the patient responsibility, right?
[AGENT][NEUTRAL] And that we're secondary, not major medical, so that would be determined by the provider. We don't determine patient responsibility.
[CUSTOMER][NEUTRAL] And what is the time finding for a deadly?
[AGENT][NEUTRAL] timely filing for what? I apologize.
[CUSTOMER][POSITIVE] Very, very good.
[AGENT][NEUTRAL] Corrected claim. There's no tell filing for a corrected claim.
[CUSTOMER][NEUTRAL] 120 days.
[AGENT][NEGATIVE] For a corrected claim, there's no timely filing.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I get the fax address or the something like that for future reference.
[AGENT][NEUTRAL] There is an appeal time frame.
[CUSTOMER][NEUTRAL] Fax number
[AGENT][NEUTRAL] The appeal time frame is 180 days from the date of denial, and that can be sent to by fax to APL claims.
[AGENT][NEUTRAL] And the um if you send a corrected claim, it can be sent by fax as well. Our claims fax number is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh, can you repeat that number? 877.
[AGENT][NEUTRAL] Sure. 877.
[AGENT][NEUTRAL] 365
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] My pleasure. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK, can I call this now?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] And can you fax me that up to you as well.
[AGENT][NEUTRAL] EOBs are obtainable on our provider portal.
[CUSTOMER][NEUTRAL] Can you copy, send me a copy of
[AGENT][NEUTRAL] It's a self-registration and that portal address is secured and it's [PII] [PII].
[CUSTOMER][NEUTRAL] Can you repeat one more time?
[AGENT][NEUTRAL] Sure, it's secured and that's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] It's self-registration using the tax ID number and the patient's account number in box 26 on the head.
[AGENT][NEUTRAL] And then you'll have that EOB instantly once you create that account.
[CUSTOMER][NEUTRAL] It
[AGENT][POSITIVE] If you need assistance, I can help you create an account real quick.
[AGENT][NEUTRAL] To get that EOB?
[CUSTOMER][NEUTRAL] Yeah, I'm working on that.
[AGENT][NEUTRAL] So if you're
[CUSTOMER][NEUTRAL] Uh, I got you that is.
[AGENT][NEUTRAL] If you're creating an account when you get to the patient account number I can provide that so you don't have to look it up.
[CUSTOMER][NEUTRAL] Yes, my system is struggling a lot today, um, I tried some of some time after the.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Would you like for me to go ahead and give you that patient account number so that you have it on hand when you try it again?
[AGENT][NEUTRAL] Cause it will ask for the patient account number. Mhm.
[CUSTOMER][NEUTRAL] Just that the number I have it with.
[CUSTOMER][NEUTRAL] It is [PII] [PII], right?
[AGENT][POSITIVE] That is correct. Yes, sir.
[CUSTOMER][NEUTRAL] OK, can I get a call reference number?
[AGENT][POSITIVE] The call reference number is my name and today's date, and I spell my name [PII]. And [PII], it was a pleasure to assist you with that claim status. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] And I'm done for the day. Thank you so much. Have a good day ahead. Bye-bye.
[AGENT][POSITIVE] I hope you have a wonderful day as well, [PII]. Thank you for calling APL and take care.