AccountId: 011433970860
ContactId: 1b6590ab-b873-4844-bc36-877842f5b32f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 494850 ms
Total Talk Time (AGENT): 245624 ms
Total Talk Time (CUSTOMER): 114910 ms
Interruptions: 1
Overall Sentiment: AGENT=1.8, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/1b6590ab-b873-4844-bc36-877842f5b32f_20250328T14:56_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] speaking from Virginia Physicians for Women, and I'm calling regarding claim status for one of our patients.
[AGENT][NEUTRAL] OK, you're needing to check claim status for one member, is that correct?
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][POSITIVE] Yes, I can help you with that, and I'm so sorry. What was your name again?
[CUSTOMER][NEUTRAL] Thank you. Uh, my name is [PII] spelled as [PII] and last initial is [PII].
[AGENT][NEUTRAL] OK, [PII]. Thank you. And your callback number?
[CUSTOMER][NEUTRAL] The callback number is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, Japa.
[CUSTOMER][NEUTRAL] Yeah, sure. uh, can you please spell out your first name for me? Sorry.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And the member's policy number, please?
[CUSTOMER][NEUTRAL] Yeah, it's 01901461.
[AGENT][POSITIVE] Thank you, one moment please.
[AGENT][NEUTRAL] And deep but any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK. The patient's first name is [PII] Last name is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you and what is the data service and total bill amount, please?
[CUSTOMER][NEUTRAL] Date of service is [PII] and total bill amount is $210.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so actually the correct policy number that you should have for this particular date of service is going to be 220.
[AGENT][NEUTRAL] 389 8.
[AGENT][NEUTRAL] Again, that's 2203898.
[AGENT][NEUTRAL] And give me just in that policy.
[CUSTOMER][NEUTRAL] 220389
[AGENT][NEUTRAL] 8, because.
[CUSTOMER][NEUTRAL] You said
[CUSTOMER][NEUTRAL] 220389-9998
[AGENT][NEUTRAL] 8. No, it's just 19 and then an 8. So 2203898.
[CUSTOMER][POSITIVE] Thank you, got it.
[AGENT][NEUTRAL] You're welcome. And that policy was active from [PII].
[AGENT][NEUTRAL] So give me just a moment to see if we did receive and process the claim under this correct policy.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so we did. Um, just one moment.
[AGENT][NEUTRAL] I mean, I need to just do one thing, Deb before I pull that information up, so just one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again you said data services [PII] and the billed amount is $210 is that correct?
[CUSTOMER][POSITIVE] Yeah, ma'am, that's correct.
[AGENT][NEUTRAL] OK, so yes ma'am, this claim was received. It was received on [PII].
[AGENT][NEUTRAL] It was processed also the same, it was processed on [PII].
[AGENT][NEUTRAL] The claim number is 331.
[AGENT][NEUTRAL] 8540.
[AGENT][NEGATIVE] And this claim double was denied.
[AGENT][NEUTRAL] The reason for the denial.
[AGENT][NEGATIVE] state's policy provides no benefits.
[AGENT][NEUTRAL] For the treatment of conditions other than a sickness or injury as defined by the policy.
[CUSTOMER][NEUTRAL] Uh, can you please, uh, repeat the reason one more time?
[AGENT][POSITIVE] Yes, ma'am, I can. It states, uh-huh, policy, well, OK, let me start again. I'm sorry. Benefit.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][POSITIVE] My goodness, I'm glad it's Friday, Depa. Benefits not payable for conditions.
[AGENT][NEUTRAL] I'm sorry, on my screen. Give me just one moment.
[CUSTOMER][POSITIVE] It's OK. Take your time.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEGATIVE] Policy provides no benefits.
[AGENT][NEUTRAL] For the treatment of conditions.
[AGENT][NEUTRAL] Other than a sickness?
[AGENT][NEUTRAL] Or injury.
[AGENT][NEUTRAL] As defined by the policy.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Or entry defined by the policy, right?
[AGENT][POSITIVE] Yes, ma'am, that is correct.
[CUSTOMER][NEUTRAL] OK, so, uh, what is the time?
[AGENT][NEUTRAL] And if you make, oh, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Sir,
[AGENT][NEUTRAL] Go ahead with your question first. I was gonna.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] What is the timely filing limit, ma'am?
[AGENT][NEUTRAL] A timely filing limit for an initial claim, there is no timely filing limit. An appeal must be filed within 180 days from the date of the decision.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So for this claim timely filing is succeeded to file an appeal and to resubmit right?
[AGENT][POSITIVE] The appeal, that is correct.
[AGENT][POSITIVE] Correct, um yes.
[CUSTOMER][NEUTRAL] Mhm, OK, got it.
[AGENT][NEUTRAL] And then if you need a copy of this explanation of benefits [PII], you can print that now that you have the claim number by going to our portal.
[AGENT][NEUTRAL] At [PII].
[CUSTOMER][POSITIVE] OK, thank you. OK, ma'am, thank you so much for your assistance. Can you please provide me your reference number?
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Well, you're certainly welcome.
[AGENT][POSITIVE] Yes, ma'am. You would use my name along with today's date. And is there anything else I can help you with this morning?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Uh, no, thank you so much.
[AGENT][POSITIVE] Well, you're very welcome and thank you again for calling APL. I hope you have a very nice weekend.
[CUSTOMER][NEUTRAL] [PII] there.
[AGENT][POSITIVE] Yes ma'am thank you.