AccountId: 011433970860
ContactId: 0e991ae5-031b-4e1c-a7e5-8d62c8c77871
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 414940 ms
Total Talk Time (AGENT): 170629 ms
Total Talk Time (CUSTOMER): 132261 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/0e991ae5-031b-4e1c-a7e5-8d62c8c77871_20250430T15:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII], and I'm calling from a provider office. May I know the claim status information?
[AGENT][NEUTRAL] Yes, I can check on a claim for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII].
[AGENT][NEUTRAL] OK, thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. It's 01947991 ML8.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Oh, OK. The first name is?
[CUSTOMER][NEUTRAL] [PII], it's [PII] and the last name spelled [PII]
[AGENT][NEUTRAL] OK, um, I'm so sorry, [PII]. I think I might have misheard that policy number. Could you repeat that for me?
[CUSTOMER][NEUTRAL] It is 01947991, M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] OK, so I'm sorry that was 01947991.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so I'm.
[AGENT][NEUTRAL] That and I'm getting a um a very old policy that belongs to someone else um that's not the correct policy number for this member um let's see, would you mind spelling their last name for me again and I'll try searching for them that way.
[CUSTOMER][NEUTRAL] OK. Yeah, sure. It's [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, got you, and that's name that was [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK all right thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And did you have the date of birth for this number?
[CUSTOMER][NEUTRAL] It's a [PII].
[AGENT][POSITIVE] Got it. OK, thank you so much for that. I did find uh that policy, um, let me know when you're ready and I can give you that correct policy number.
[CUSTOMER][POSITIVE] Yeah, sure. I'm ready.
[AGENT][NEUTRAL] That is 02.
[AGENT][NEUTRAL] 10.
[AGENT][NEUTRAL] 7225.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK and then uh what was the date of service?
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and do you have that bill amount?
[CUSTOMER][NEUTRAL] It is $734.63.
[AGENT][NEUTRAL] $734.63.
[CUSTOMER][NEUTRAL] Yeah, right.
[AGENT][POSITIVE] Got it OK thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was the name of this provider's office, Richie?
[CUSTOMER][NEUTRAL] It's a for front dermatology.
[AGENT][POSITIVE] Got it thank you.
[AGENT][NEUTRAL] OK, so we did receive this claim. We were unable to pay a benefit as office visits are not covered under this policy, uh, and as well as ser um treatment in office is not covered either.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, it is not covered under the special, special plan or provider plan.
[AGENT][NEUTRAL] Under the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Did you need that claim number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] That is 358-846-2.
[CUSTOMER][NEUTRAL] OK. Uh, one last thing, can you please verify the claim mailing address?
[AGENT][NEUTRAL] Yes, that is [PII].
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Zip code is
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. The ZIP code is [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] Of course is there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] Uh, can you also provide me the, uh, fax number?
[AGENT][NEUTRAL] Yes, that is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. And one last thing, may I know the uh
[CUSTOMER][NEUTRAL] PFL limit for appeals.
[AGENT][NEUTRAL] So yeah, so, um, that would be within 180 days of the process date, and that was [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And for appeals, uh, you would simply have to uh include a letter uh stating that it is of course for an appeal.
[CUSTOMER][NEUTRAL] Can I get a call reference number? OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. Can I get a call reference number?
[AGENT][NEUTRAL] Of course
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date. Uh so my name is spelled [PII]
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you, bye bye.