AccountId: 011433970860
ContactId: 2426f625-aa47-445e-8549-4488aabf29d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 627539 ms
Total Talk Time (AGENT): 147778 ms
Total Talk Time (CUSTOMER): 165764 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/2426f625-aa47-445e-8549-4488aabf29d3_20250122T14:07_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office to check on a bill status. Could you please help us?
[AGENT][POSITIVE] Yes, I can help you with that. How do you spell your name?
[CUSTOMER][NEUTRAL] [PII] And my initial to the last name is [PII]. Could you please spell out your name for documentation purpose?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] May I know your initial last name?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much, ma'am.
[AGENT][NEUTRAL] And do you have a callback number I can get?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Extension is [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, ma'am. The policy number is 2505485.
[AGENT][NEUTRAL] Thank you, hold on one moment please.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Patient's name?
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] And the date of birth
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you wanted claim status?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I can look that up for you. What data service?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] And what's the procedure code?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 99285
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Hold on one moment, please.
[CUSTOMER][POSITIVE] Yeah, sure, take your time.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, that claim was denied.
[CUSTOMER][NEUTRAL] Uh, may I know the denied reason, ma'am?
[AGENT][NEUTRAL] Our records indicate that premium for this data service was not received. Therefore, no benefits are payable at this time.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Uh, the member didn't pay the premium, uh, for the data service, right? OK.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] For the policy.
[CUSTOMER][NEUTRAL] OK, ma'am.
[CUSTOMER][NEUTRAL] Uh, could you please hold for a moment, ma'am?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, ma'am, can I get the call reference number, ma'am?
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, ma'am. Uh, could you please, uh,
[CUSTOMER][NEUTRAL] Uh, tell me, uh, the patient, uh, uh, eligibility date, effective term date.
[AGENT][NEUTRAL] The term date, it just depends on what the date of service is. It's uh [PII], but see this group pays weekly, so we did not receive for that week of [PII], so the effective date is [PII].
[CUSTOMER][POSITIVE] Thank you so much, ma'am. I have one more thing. Could you please help us with us?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Is it on the same person?
[CUSTOMER][NEUTRAL] No, ma'am. Different member.
[AGENT][NEUTRAL] OK, I can help you with one more. What's the policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the policy number is
[CUSTOMER][NEUTRAL] D. Delta 43730574.
[AGENT][NEUTRAL] That's not one of our policy numbers. Do you have their social security number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I have another policy number. Could you just decide that? Yeah, it's [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Patient's name.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The first name is [PII] and last name is [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII], sorry, [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Procedure code.
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] 99284
[AGENT][NEUTRAL] And that was 87.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] No, ma'am. [PII].
[AGENT][NEUTRAL] 0, 4724.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Benefit maximum for this data service has been met. It was denied, so a max was met already on another claim.
[CUSTOMER][POSITIVE] Maximum benefit, ma'am, for this plan?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, may I know the, when was the maximum benefits me?
[AGENT][NEUTRAL] When the max was met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, date.
[AGENT][NEUTRAL] On another claim for the same data service.
[CUSTOMER][NEUTRAL] For uh for same.
[CUSTOMER][NEUTRAL] Uh, tax ID, ma'am, or different tax ID?
[AGENT][NEGATIVE] I can't understand what you're saying.
[CUSTOMER][NEUTRAL] OK. The, it's for same provider or different provider, ma'am?
[AGENT][NEUTRAL] Different provider. It was for the facility bill.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] One moment, ma'am.
[CUSTOMER][NEUTRAL] OK. For this claim, uh, we submitted a reconsideration uh to the mailing address on [PII], ma'am. Uh, may I know the status of that, ma'am?
[AGENT][NEGATIVE] We've done, we've received it 5 or 6 times. I'm gonna give you the one that we actually denied.
[CUSTOMER][NEUTRAL] Uh, OK. Since it was a different provider, could you please take this claim for reprocess, ma'am?
[AGENT][NEGATIVE] We cannot because the maximum was met for that data service there's nothing else payable.
[AGENT][NEUTRAL] It was processed 58 of 24.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] But you can send in an appeal if you would like, but there's no reason to reprocess it because the max was met.
[CUSTOMER][NEUTRAL] OK. May I know the uh mailing address, ma'am?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] May I know the timely filing limit to send an appeal, ma'am?
[AGENT][NEGATIVE] We don't have timely filing.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh, thank you so much, ma'am. Uh, thank you for assisting. Have a great day, ma'am. Bye-bye.
[AGENT][POSITIVE] Thank you, [PII] for calling APL. You have a good day as well. Bye-bye.