AccountId: 011433970860
ContactId: ffd99d90-726a-4c62-b807-63624c9604a2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 452869 ms
Total Talk Time (AGENT): 138204 ms
Total Talk Time (CUSTOMER): 105392 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/ffd99d90-726a-4c62-b807-63624c9604a2_20250127T20:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from provider office to checking for claim status.
[AGENT][NEUTRAL] I can help you, [PII]. How do you spell your name?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yup. My name is spelled [PII]
[AGENT][NEUTRAL] How do you pronounce your name? [PII]?
[CUSTOMER][POSITIVE] [PII], yeah, that's correct.
[AGENT][NEUTRAL] Oh, OK, and you said you're checking claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Can I get the policy number and a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] The phone number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it's a direct line?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the policy number is 021-67817.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII].
[CUSTOMER][NEUTRAL] Date of birth, [PII].
[AGENT][NEUTRAL] OK, and you said that you're checking a claim status.
[AGENT][NEUTRAL] And if you could provide the date of service in the chart, we can help you with that uh status.
[CUSTOMER][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] And this claimable for.
[CUSTOMER][NEUTRAL] $275 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I'm showing this claim was received [PII].
[AGENT][NEUTRAL] And processed [PII], uh, the explanation was mailed the next business day to the address on your claim. Uh there was no payment made. Outpatient facility is not covered under this policy for, so it was denied for that reason.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Chernopa? OK.
[CUSTOMER][NEUTRAL] I, I'm here. I'm just nosing.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much for the information. Can you spell your name, please?
[AGENT][NEUTRAL] Hm, you'll use my name and today's status reference for today's call, [PII].
[AGENT][NEUTRAL] ONYA first initial last name is [PII]. And you can also check claim status on our online service center at [PII]. And any other questions?
[CUSTOMER][NEUTRAL] Yeah. Could you please help me with the fax number for the billing?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Attention appeals.
[AGENT][NEUTRAL] And the claim would need to be submitted prior to 180 days from the date of the claim decision.
[CUSTOMER][NEUTRAL] And the date of this decision.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I, I didn't understand what you said.
[CUSTOMER][NEUTRAL] 180 days from the date, uh 180 days from the date of this decision, right? A should be somewhere within 180 days, OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm, and submit any pertinent information.
[CUSTOMER][NEUTRAL] And uh, what is the mailing address?
[AGENT][NEUTRAL] It's the same as the claim's mailing address.
[CUSTOMER][NEUTRAL] Uh, if you don't want to you please
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And while submitting the bill, do we need to attach any form, anything else apart from that?
[AGENT][NEGATIVE] Not necessarily if there's a form, but you need to state that make it to the attention of appeals and you need to supply any support it, uh, documentation, um, as to why you want the claim reprocessed. Otherwise, it's, it's gonna be denied because it's not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much for this information.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh one moment, just a minute, please.
[CUSTOMER][NEUTRAL] OK, I just wanted to check one more for the number. Uh, I'm sure, uh, it's the same date of service [PII]. There was a bill for $150.
[AGENT][NEUTRAL] Is it for this patient?
[CUSTOMER][NEUTRAL] Yeah, for the same number.
[AGENT][NEUTRAL] And what's the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] denied for the same reason, the claim number.
[AGENT][NEUTRAL] And what was the charge for that day?
[CUSTOMER][NEUTRAL] $150.
[AGENT][NEUTRAL] And what's the procedure code on the claim?
[CUSTOMER][NEUTRAL] The procedure code, let me check, just a minute.
[CUSTOMER][POSITIVE] OK, this is Bel for.
[CUSTOMER][NEUTRAL] Post code [PII].
[AGENT][NEUTRAL] OK, so was that a, an X-ray?
[AGENT][NEUTRAL] Or diagnostic test?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so it was denied as diagnosed this testing, this test is not covered by the patient's policy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that claim number is 3341071.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. 234107. OK, and I will go to, to whom, uh, which insurance name it will go?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] American Public Life.
[AGENT][NEUTRAL] Any other questions?