AccountId: 011433970860
ContactId: 12e7835e-de1e-465b-a1d0-ca00d766d7be
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 305440 ms
Total Talk Time (AGENT): 107981 ms
Total Talk Time (CUSTOMER): 117594 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/12e7835e-de1e-465b-a1d0-ca00d766d7be_20250228T19:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm calling for provider Stuart Medical Group INC to check an additional information about claim that has been denied. Please note this call will be monitored and recorded for the quality and training purpose. I have already checked to you and I need clarification on denied.
[AGENT][NEUTRAL] She
[AGENT][NEUTRAL] Yes, I could take a look at that claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's going to be [PII], and there is no extension for the direct line.
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's going to be.
[CUSTOMER][NEUTRAL] 14190553 M as in Mike. L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you. And what was the name and date of birth for the insured? Oh, I'm sorry, actually, I apologize, [PII]. Um, I think I misheard that policy number. Could you repeat that?
[CUSTOMER][NEUTRAL] It's going to be 14190553 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, so there appears to be uh an additional digit um in front of that ML 8 there's one extra number.
[CUSTOMER][NEUTRAL] Uh, just a moment. I have the.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes I have the policy number. Could you please go with that?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 01419053.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, uh, what was the name and date of birth for the member?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, the member name is going to be.
[CUSTOMER][NEUTRAL] [PII] and
[CUSTOMER][NEUTRAL] [PII] and the date of birth is going to be [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII] and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Date of service it's going to be?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And with the bill amount.
[CUSTOMER][NEUTRAL] $60 even.
[AGENT][NEUTRAL] Uh $60.60.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you, one moment please.
[CUSTOMER][NEUTRAL] Uh, just a moment. The total bill amount is going to be uh.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] $448.
[AGENT][POSITIVE] OK, thank you for that.
[AGENT][NEUTRAL] OK, so we did receive this claim, [PII], uh, we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Is it means uh
[CUSTOMER][NEUTRAL] And be able, uh, unable to pay a benefits of the member's plan or the
[AGENT][NEUTRAL] The member's plan, yes, this member's plan does not cover office visits.
[CUSTOMER][NEUTRAL] Is it non good as for the members?
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[CUSTOMER][NEUTRAL] Yes, could you please help me with the uh correct claim filing limit and the corrected mailing address for my documentation?
[AGENT][NEUTRAL] Um, I'm sorry, [PII], uh, you needed our mailing address?
[CUSTOMER][NEUTRAL] Yes, I need the corrected claim filing limit and the corrected claim mailing address.
[AGENT][NEUTRAL] OK, so do you mean for an appeal?
[CUSTOMER][NEUTRAL] Uh, just for my documentation.
[AGENT][NEUTRAL] So for an appeal it has to be within 180 days of that process date and this claim was processed.
[CUSTOMER][NEUTRAL] Uh, sorry for interruption.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I'm not, uh, sorry for interruption. I'm not talking about the appeal filing limit. I'm talking about the corrected claim filing limit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, there's no, there's no timely filing limit just for filing claims, um, and our mailing address is [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Could you please help me with the call reference number for this claim?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Um so my name is spelled [PII], last [PII] was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] So, thank you so much and have a nice day. Bye-bye.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.