AccountId: 011433970860
ContactId: 26457893-2786-48fb-992c-bd3a1207e0c2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 280559 ms
Total Talk Time (AGENT): 91191 ms
Total Talk Time (CUSTOMER): 62690 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/26457893-2786-48fb-992c-bd3a1207e0c2_20250508T12:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, sir. Uh, my name is [PII] calling the provider office to check on the claim status. Please be informed that this call is being recorded and monitored for quality and training purpose. How are you doing today?
[AGENT][POSITIVE] I'm good, thank you for asking. I'm happy to check on a claim. Can I get the policy number?
[CUSTOMER][POSITIVE] Thank you for asking
[CUSTOMER][NEUTRAL] Oh yes, that's 02479242.
[AGENT][NEUTRAL] Patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Oh yes, the patient's name is [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] And just to reconfirm, policy number was 02479242?
[CUSTOMER][NEUTRAL] Uh, just give me a moment. Let me double check and confirm once.
[CUSTOMER][NEUTRAL] So I think uh oh it's a different one. That's 02419242.
[CUSTOMER][POSITIVE] I'm sorry about that.
[AGENT][NEUTRAL] That's all right, let me try that one moment.
[AGENT][NEUTRAL] What was the name again?
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] All right, thank you. And then what is the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] And the build amount.
[CUSTOMER][NEUTRAL] It's $211.05.
[AGENT][NEUTRAL] All right, thank you, one moment.
[CUSTOMER][POSITIVE] Sure, please take your time.
[AGENT][NEUTRAL] Do you by chance have a different amount after the primary or is that the amount the 21105?
[CUSTOMER][NEUTRAL] It might be $206.04.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][POSITIVE] Yes, yes, sir, it's OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Thank you for your patience on that. So we did receive a claim for the state of service. A claim was received on [PII].
[AGENT][NEUTRAL] The claim was denied on [PII]. Office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get the claim number?
[AGENT][NEUTRAL] That would be 357-589-5.
[CUSTOMER][NEUTRAL] OK, just to confirm, the claim is denied for non-core on the member's plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, thank you. Can I get the mailing address just for my documentation purpose?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Thank you. And may I know the timely filing limit to submit an appeal?
[AGENT][NEUTRAL] Appeals must be filed within 180 days of the decision.
[CUSTOMER][NEUTRAL] Yes, sir. Thank you. Can I get the reference number for our call [PII]?
[AGENT][NEUTRAL] Call reference is my name with my last initial and today's date. My name again is [PII], last initial [PII], then today's date.
[CUSTOMER][POSITIVE] OK, thank you, sir. Thank you for assisting. Have a good rest of your day.
[AGENT][NEUTRAL] You too bye bye.