AccountId: 011433970860
ContactId: 02232750-d626-4a51-8758-e310e0d67ab7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 251839 ms
Total Talk Time (AGENT): 62354 ms
Total Talk Time (CUSTOMER): 100587 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/02232750-d626-4a51-8758-e310e0d67ab7_20250210T20:15_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Um, hi [PII], my name is [PII], and I'm with the broker's office, and I'm trying to check um on a claim, um, that I actually had, um, faxed in for a member.
[CUSTOMER][NEUTRAL] Um, about 10 days ago.
[AGENT][POSITIVE] OK, I'd be happy to assist with the claim, Miss [PII]. I can get a good call back number for you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] It is um.
[CUSTOMER][NEUTRAL] 02129475
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And what's the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, we.
[AGENT][NEUTRAL] Let me see because we received multiple claims on that date um.
[AGENT][NEUTRAL] What day did you fax it?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, I think there I think I might have sent more than one.
[AGENT][NEUTRAL] Oh, OK. Uh it's 2, it's a [PII] and a.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, the [PII] I definitely.
[CUSTOMER][NEUTRAL] Sent that one let me see if I've sent anything else.
[AGENT][NEUTRAL] So for the [PII] claim.
[AGENT][NEUTRAL] That was processed.
[AGENT][NEUTRAL] And we advise the member that uh the policy benefits were paid to the provider.
[CUSTOMER][NEUTRAL] Oh, the provider had filed a claim?
[AGENT][NEUTRAL] Yeah, let's see when did they file one moment um.
[AGENT][NEUTRAL] Yes, provider filed [PII] and we made payment [PII].
[CUSTOMER][NEUTRAL] Payment
[CUSTOMER][NEUTRAL] Right on.
[CUSTOMER][NEUTRAL] And can you tell me what amount was paid to the provider?
[AGENT][NEUTRAL] Um, $2,934.48 and that maxed out the outpatient, so that's all they had left for their outpatient when we received that claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess she, I don't know if she's gotten a bill or whatever but I guess she wasn't aware that the provider had filed obviously, um, OK, um, and then I have a question for you that's kind of a general question for the med link not I have a different group who has um medling gap policy um for their employees. What is the time limit that you can file a claim for?
[AGENT][NEGATIVE] We don't have time to filing.
[CUSTOMER][NEUTRAL] How far back will you go?
[CUSTOMER][NEUTRAL] Oh, you don't, so it doesn't matter how far.
[AGENT][NEUTRAL] We'll go back to the, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Yeah I was gonna say you'll go back.
[CUSTOMER][NEUTRAL] To whenever?
[AGENT][NEUTRAL] Correct, we'll go back to.
[CUSTOMER][NEUTRAL] As long as the policy was in force.
[CUSTOMER][NEUTRAL] OK, good to know because I've got one that's about 2.5 years old and I was afraid that there was a time limit on it.
[CUSTOMER][POSITIVE] Um, all right, thank you.
[AGENT][NEUTRAL] Is there anything else I can assist with today?
[CUSTOMER][POSITIVE] Uh, no, ma'am, that's all, thank you.
[AGENT][POSITIVE] Thank you for calling APO. You have a good day.
[CUSTOMER][POSITIVE] Have a good day.
[CUSTOMER][NEUTRAL] You too bye.