AccountId: 011433970860
ContactId: 05cb29bc-1209-4857-bbbe-78e59b69752e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 735349 ms
Total Talk Time (AGENT): 219975 ms
Total Talk Time (CUSTOMER): 171131 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/05cb29bc-1209-4857-bbbe-78e59b69752e_20250107T18:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII]. I'm calling you for the provider's office to check the claim status.
[AGENT][NEUTRAL] Hey, yeah, I can check on a claim for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] Any OK, and can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. That will be [PII].
[AGENT][NEUTRAL] All right, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] That will be 0247326.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] OK, um, I think I missed a digit in there [PII]. I'm so sorry, could you repeat that policy number for me?
[CUSTOMER][NEUTRAL] Oh yeah, sure, no problem. It's 0247326 M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] OK, so we're missing a digit um before the ML 8.
[AGENT][NEUTRAL] That's not a complete policy number. I'm, I'm not pulling anything up with that. Um, do you maybe have their social I could search for them that way?
[CUSTOMER][NEUTRAL] Uh, let me check. Give me a second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Patient card.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, let me check in a claim form once.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I can see the same member ID.
[AGENT][NEUTRAL] Does it have an additional digit?
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] Um, if you don't have the social, I could try searching if you don't mind spelling out their first and last name. I could try that.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, one moment please.
[AGENT][NEUTRAL] Uh, what state, uh, does this insured live in?
[CUSTOMER][NEUTRAL] Mhm it's [PII].
[AGENT][NEUTRAL] OK, do you have the date of birth?
[CUSTOMER][NEUTRAL] Yeah, uh, it's [PII].
[AGENT][NEUTRAL] Perfect. OK, so I did find it. Um, all right, so the policy number, um, it had a 4 after the 6. So the policy number is 02473264.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] ML 8
[AGENT][NEUTRAL] Yeah, yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, let's see, what was the date of service for this claim, [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, I'm sorry, that was [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what was the bill amount?
[CUSTOMER][NEUTRAL] Sure. It's um
[CUSTOMER][NEUTRAL] $303 even.
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so we did receive this claim at any, um, it's stating that this is not covered under their policy. See.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Kinesiology, speech or occupational therapy is not covered under this policy.
[CUSTOMER][NEUTRAL] OK. When it was received?
[AGENT][NEUTRAL] Uh, one moment, let me get that for you.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Um, it's claim was received [PII].
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It was denied, right?
[AGENT][NEGATIVE] Correct, it was not covered under this policy.
[CUSTOMER][NEUTRAL] OK. Just a second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. You told me that it's not covered under the policy. It's under the patient policy, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, and just
[CUSTOMER][NEUTRAL] Uh, can we appeal for this?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Uh, can we appeal for this?
[AGENT][NEUTRAL] Oh, we don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] Uh, OK, so that we don't have option to appeal this.
[AGENT][NEUTRAL] Um, and as it's not covered, um, no, it's not going to be, I mean, you can, but it's not a covered, uh, policy, or under this policy.
[CUSTOMER][NEUTRAL] OK, bear with me. I'm having quite out here, just a second.
[AGENT][NEUTRAL] You're fine.
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Thank you so much for your patience. Until that, um, I have two more claims for the different date of service for the same claim like uh on [PII].
[AGENT][NEUTRAL] Uh, this is for the same member?
[CUSTOMER][NEUTRAL] Yeah, same number, same amount.
[AGENT][NEUTRAL] Oh, the same amount, OK, but you said [PII]. Alright, give me just a moment.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, so this claim, uh, was denied for the same reason, GD, as it was not covered under their policy.
[CUSTOMER][NEUTRAL] Uh, can, can I get the receipt date for this?
[AGENT][NEUTRAL] Of course that was uh this 1 [PII], and then it was processed to [PII].
[CUSTOMER][NEUTRAL] OK, denied for the same reason.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And one more uh date of service is [PII].
[AGENT][NEUTRAL] Same build amount.
[CUSTOMER][NEUTRAL] Yeah, same amount.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] OK, yes, so we received this one as well and again same denial reason.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this one was
[CUSTOMER][NEUTRAL] On which date?
[AGENT][NEUTRAL] Yes, received [PII], and this one was processed [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can I get the claim number for these 3 claims?
[AGENT][NEUTRAL] Of course, OK, so the first one that was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Second one was [PII].
[AGENT][NEUTRAL] And then this last one is uh [PII].
[CUSTOMER][NEUTRAL] OK. Uh, can we go to this patient?
[AGENT][NEUTRAL] We do not say what is patient responsibility and so that would be up to the provider.
[CUSTOMER][NEUTRAL] OK. It's uh it's up to us like, can we do or?
[CUSTOMER][POSITIVE] If we are we are having an option, we can do, right?
[AGENT][NEUTRAL] It that would be up to the provider, yes, we don't say one way or the other.
[CUSTOMER][NEUTRAL] Oh, OK. Just a second. I'm sorry for this, keeping on hold for you. No.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] No, you are perfectly fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, thank you so much and sorry for the delay and uh can you please fax me a copy of AOB?
[AGENT][NEUTRAL] You're fine.
[AGENT][NEUTRAL] Uh, all three of them.
[CUSTOMER][NEUTRAL] Uh yeah, please.
[AGENT][NEUTRAL] Sure, what's that fax number for you?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII] and the extension is to my name.
[AGENT][NEUTRAL] OK, OK, alrighty, I will get them sent to you, um, should get them in maybe 10-15 minutes depending on how busy your machine is. Uh, was there anything else I could help you with [PII]?
[CUSTOMER][NEUTRAL] Oh, yeah.
[CUSTOMER][NEUTRAL] Uh, yeah, that's all. And before that, can I get a call reference number?
[AGENT][NEUTRAL] Yeah, reference number would just be my first name, last initial, and today's date and so my name is spelled [PII] last initial is [PII]
[CUSTOMER][POSITIVE] Thank you, [PII], for valuable information and your patience.
[AGENT][POSITIVE] Of course, yeah, thanks for calling APLN. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too bye bye take care.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm