AccountId: 011433970860
ContactId: 10b1ad6f-68bc-4c8d-87a0-ad79dcf00307
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 501140 ms
Total Talk Time (AGENT): 202097 ms
Total Talk Time (CUSTOMER): 168303 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/10b1ad6f-68bc-4c8d-87a0-ad79dcf00307_20250605T16:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider office to checking a claim in clerk fashion.
[AGENT][NEUTRAL] I'm sorry, uh, we're checking on a claim.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Claim denied clarification, yes.
[AGENT][NEUTRAL] Oh sure, yeah I can get clarification on that claim. uh [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have that policy number?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Yes, just a moment, the policy number is.
[CUSTOMER][NEUTRAL] 04012021.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, um, I'm sorry, [PII], would you mind repeating that policy number please?
[CUSTOMER][NEUTRAL] Sure. 040.
[CUSTOMER][NEUTRAL] 12021.
[AGENT][NEUTRAL] OK, so I did not get a result with that policy number that does not appear to be one of our policy numbers. um, do you maybe have the members social I could search for them that way or if you have that claim number I can search that way as well.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh just a moment. Can I provide the member name and date of birth?
[AGENT][NEUTRAL] Uh, if you wouldn't mind spelling out the first and last name please.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sure. [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Last name is
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I'm sorry, that was [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK all right thank you one moment.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK and then do you have the member's date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. I did find their policy with us. uh, do you want me to go ahead and give you that correct policy number?
[CUSTOMER][NEUTRAL] Mm, could you please provide that one?
[AGENT][NEUTRAL] Yes, it is 0232.
[AGENT][NEUTRAL] 367 2.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Alright and then uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] This one is [PII].
[CUSTOMER][NEUTRAL] With the total bill amount is $294 even.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, so for this claim Victor we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] It's not.
[CUSTOMER][NEGATIVE] But we are checking denied as a lack of information on submission.
[AGENT][NEUTRAL] What was that? I'm sorry.
[CUSTOMER][NEUTRAL] Could you please confirm?
[CUSTOMER][NEUTRAL] Be checking up on maybe it's denied as a claim or services lack of information or has submission or billing error. No other reason we can found. Could you please confirm that one denied? It's a lack of information or not covered.
[AGENT][NEGATIVE] Yeah, so I'm showing this claim was received twice. Sure, I'm showing this claim has been received twice, one denied as a duplicate. The original did deny as office visits are not covered.
[CUSTOMER][NEUTRAL] Could you please provide the claim overall status when you receive this claim?
[AGENT][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] Sure, so this claim was originally received [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] OK. Claim number?
[AGENT][NEUTRAL] 356-452-7
[CUSTOMER][NEUTRAL] 356-452-7. Am I right?
[AGENT][NEUTRAL] 356-452-7
[CUSTOMER][NEUTRAL] OK. Where the delight date?
[AGENT][NEUTRAL] And that was the process date that was [PII].
[CUSTOMER][NEUTRAL] Mhm. For this one, is it not covered, could you please provide the mailing address?
[AGENT][NEUTRAL] Yes, that is a [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, when is the time you I let me drop it?
[AGENT][NEUTRAL] For appeals that would be within 180 days of the process date and if you were to uh send an appeal to us you would have to include a letter stating that of course it is an appeal.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, for this uh uh Karaka mailing address.
[AGENT][NEUTRAL] Uh, that is the mailing address for claims and for appeals that I gave you.
[CUSTOMER][NEUTRAL] OK. OK. What is the timely finding limit to submit on a contact line?
[AGENT][NEUTRAL] But for appeals timely filing limit is 180 days of the process date. Um, any missing information or incorrect information, there is no timely filing limit.
[CUSTOMER][NEUTRAL] No, I'm asking about the current time, timely filing limit.
[AGENT][NEUTRAL] Right, so that there's no timely filing limit.
[CUSTOMER][NEUTRAL] No time to finding limit. Got it. And uh could you please spell out your name for me?
[AGENT][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, yes, sir, just a moment. Could you please for the duplicate claim number.
[AGENT][NEUTRAL] Oh yes, uh, that is 358 7.
[AGENT][NEUTRAL] 273.
[CUSTOMER][NEUTRAL] When it is received and when it's duplicate.
[AGENT][NEUTRAL] The duplicate was received uh [PII].
[AGENT][NEUTRAL] And was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it. For this one, could you please send the UOB through fax for the denied one?
[AGENT][NEUTRAL] Uh, for the original?
[CUSTOMER][NEUTRAL] Which is an office visit. OK, yes, original.
[AGENT][POSITIVE] Yes, yeah, absolutely, uh, what was that fax number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] Attention to my name.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Got it. OK, I will go ahead and send that now. I should get it within about 10 minutes or so.
[CUSTOMER][NEUTRAL] And finally,
[CUSTOMER][NEUTRAL] OK. Finally, could you please provide the member plan type?
[AGENT][NEUTRAL] Uh, this is a secondary, yes, it's a secondary medical policy.
[CUSTOMER][NEUTRAL] And plan name.
[AGENT][NEUTRAL] The plan name is Medlik M E D L I N K.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][POSITIVE] OK, perfect type.
[CUSTOMER][NEUTRAL] It's a plan G or plan A.
[AGENT][NEUTRAL] Neither, it is a secondary medical policy is supplemental.
[CUSTOMER][NEUTRAL] Supplement.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Got it. And finally, could you please provide the customer reference number?
[AGENT][NEUTRAL] A reference number would just be my first name, last initial, and today's date, uh, so my last initial is A.
[CUSTOMER][POSITIVE] Thank you, sir. Thank you so much for providing information done for the day. Have a nice day to you.
[AGENT][POSITIVE] Of course, yeah, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Yeah.