AccountId: 011433970860
ContactId: fe496fb3-1ad7-4632-a799-fa00ccc3396f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 626140 ms
Total Talk Time (AGENT): 138880 ms
Total Talk Time (CUSTOMER): 156964 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/fe496fb3-1ad7-4632-a799-fa00ccc3396f_20250407T17:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. How are you?
[AGENT][POSITIVE] I am good how are you?
[CUSTOMER][POSITIVE] I'm also doing great, and this is [PII] calling from the provider's office to look upon the claim status. Can you please help me with that?
[AGENT][NEUTRAL] And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII] the [PII] would be [PII].
[AGENT][NEUTRAL] What is the policy number, please?
[CUSTOMER][NEUTRAL] Yeah, hold on, let me check that.
[CUSTOMER][NEUTRAL] Yeah, the policy number is 01852040.
[CUSTOMER][NEUTRAL] M L H
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] The patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for the information and you're calling for claim status. I can assist you. What is the date of service and total charge amount please?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII], and the bill amount was $72,456. 37 cents.
[AGENT][NEUTRAL] OK, so that was [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] thank you and the total charges were $72,456.37.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And also [PII], you're able to check claim status and receive EOBs from our secure website at [PII].
[AGENT][NEUTRAL] Um, give me one second here. I believe I show that claim. Give me one moment. Can I place you on hold please, [PII]?
[CUSTOMER][POSITIVE] Yeah, sure. Take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you so much for your patience [PII]. The claim was received on [PII] and processed and denied on [PII].
[AGENT][NEUTRAL] And a claim denied as?
[CUSTOMER][NEUTRAL] Uh, what was the denied date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And there you know the reason?
[AGENT][NEUTRAL] Um, this is not a rendered covered place of service.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEGATIVE] The place of service is not covered.
[CUSTOMER][NEUTRAL] OK, uh, the place of service is not covered. OK, hold on, let me check that.
[CUSTOMER][NEUTRAL] Yeah, as I can see, the provider which has rendered services is contracted.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Again it was a non-covered place of service so that's why the claim was denied.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so, uh, the claim is has been denied stating that uh it is not covered uh as place of service, yeah.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And uh I can see uh the facility which the patient has taken services has been contracted and the period start date of the contract was [PII] uh so this.
[CUSTOMER][NEGATIVE] The, uh, denial is basically incorrect.
[AGENT][NEUTRAL] Par
[CUSTOMER][NEUTRAL] Because we are a contracted, yeah.
[AGENT][NEUTRAL] I'm sorry, I'm so sorry. OK. The claim was denied. It shows that this took place at home dialysis, and this is not a covered place of service per the policy, so it denied as a non-covered place of service.
[CUSTOMER][NEUTRAL] Sure, go on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, hold on, let me check that.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, hold on, let me ask my supervisor.
[CUSTOMER][NEUTRAL] OK. So, as I asked my supervisor, so he's telling me that, can you please verify the place of service?
[AGENT][NEUTRAL] Per the policy excuse me, per the submission of the UBO4 it shows FKC VIP home dialysis.
[CUSTOMER][NEUTRAL] OK, uh, hold on, let me check this.
[CUSTOMER][NEUTRAL] See in my system that this is just the name and this is a center or dialysis center.
[AGENT][NEUTRAL] That is correct and it's not a covered place of service. If you'd like to send the appeal, you can. You have 180 days from the decision to send an appeal. I can give the information to you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK thank you
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] OK, and you have 180 days from the claim decision date and that claim processed on give me [PII]. You can send your documentation to APL claims.
[AGENT][NEUTRAL] Attention appeals department.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me provide you with