AccountId: 011433970860
ContactId: 29f685da-56d4-40fa-8f7b-6eb5d6b4633c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 451779 ms
Total Talk Time (AGENT): 159435 ms
Total Talk Time (CUSTOMER): 140890 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/29f685da-56d4-40fa-8f7b-6eb5d6b4633c_20250416T14:48_UTC.wav
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[AGENT][NEUTRAL] My sister.
[AGENT][NEUTRAL] Hello, thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII].
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm calling from the provider office to check on the claim status.
[AGENT][NEUTRAL] Sure, [PII], I could assist you with that. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes, the callback number is [PII]. And it's a direct line?
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] OK. It is D as in Delta 42005319.
[AGENT][NEUTRAL] I do apologize, but that's not a policy number here at American Public Life. Do you have the member's social?
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK, the SSN is [PII].
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][NEUTRAL] And what is the member's name?
[CUSTOMER][NEUTRAL] Ma'am, the first name is [PII] and the last name is [PII]
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][NEUTRAL] And the last name?
[CUSTOMER][NEUTRAL] It is [PII]
[AGENT][NEUTRAL] So, I'm not sure if you're saying, could you, when you spell the last name, could you say [PII], cause I'm not catching all of the letters.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. It's [PII].
[AGENT][NEUTRAL] So that's [PII].
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][NEUTRAL] And the first name is [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm not showing that name in the system. Give me one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEGATIVE] Jeez. Spell his last name one more time.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] What city and state does this member live in?
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Let me give you the correct policy number.
[AGENT][NEUTRAL] This is for medical, correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It is 1814655. That's 18146555.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the date of service that you're calling to check the status of the claim for [PII]?
[CUSTOMER][NEUTRAL] It is [PII] and the charge amount is $170 even.
[AGENT][POSITIVE] 6116. Thank you.
[CUSTOMER][POSITIVE] So for this one we have sent an appeal. I just wanna.
[AGENT][NEUTRAL] So this claim was received.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] The claim was received [PII] was processed [PII]. There was no payment made on the claim.
[CUSTOMER][NEUTRAL] Yes, it stated it got denied. So we have sent an appeal on [PII] with medical records through a fax. So I just wanted to confirm what is the current status of an appeal.
[AGENT][NEUTRAL] So I'm not showing an appeal on file at the moment, but it was denied because the benefits were maxed out.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] There, there's a maximum benefit amount, but they were denied due to the lack of benefits available.
[CUSTOMER][NEUTRAL] For that one we have.
[AGENT][NEUTRAL] And when did you say that you sent the pill in?
[CUSTOMER][NEUTRAL] OK. So we have initially sent an appeal on [PII] and stated there is no appeal on file. And again, we sent an appeal on [PII]. And the fax number is [PII]. Is this the right one?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] So you might want to send a pill by mail.
[AGENT][NEUTRAL] Cause I'm not showing anything on file.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So there is no bill on file?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] So can you please confirm the mailing address? OK, take your time.
[AGENT][NEUTRAL] I'm looking
[AGENT][NEGATIVE] If I'm looking, I'm not showing anything for the and I don't see an appeal for that date of service.
[CUSTOMER][NEUTRAL] Mhm OK so.
[CUSTOMER][NEUTRAL] Just confirm the mailing address is [PII], OK, [PII]. Is this right, No?
[AGENT][NEUTRAL] That is correct. We have a payer ID as well.
[AGENT][NEUTRAL] Would you like to pay your ID?
[CUSTOMER][NEUTRAL] So can I send an
[CUSTOMER][NEUTRAL] Uh, for a bill, you still require any payer ID? I'm not supposed to.
[AGENT][NEUTRAL] The payer ID is 60801 but I'm not sure, but I do know the method you're saying that you're sending it to us by fax.
[AGENT][NEUTRAL] At [PII] and unfortunately we have not received it because we don't have it on file. However, I suggest that you send it to us by mail so that way it could be sent to us and received. I will send it certified so that way you'll get verification of delivery.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So we'll send through our mail and can I get the that's it from my end. Can I get the call reference number for this one?
[AGENT][NEUTRAL] We don't provide the reference numbers. However, you can use my name in today's date as a reference. It's S as in [PII] and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much, Doctor [PII] and have a great day right now bye bye.
[AGENT][POSITIVE] You're welcome, and [PII]. Thanks for calling APL. Have a good day. Goodbye.
[CUSTOMER][NEUTRAL] Mhm.