AccountId: 011433970860
ContactId: 34458515-45b6-4843-81c9-7e056eb5956a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 617429 ms
Total Talk Time (AGENT): 157230 ms
Total Talk Time (CUSTOMER): 190790 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/34458515-45b6-4843-81c9-7e056eb5956a_20250606T19:02_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm [PII] calling from product office regarding claims.
[AGENT][NEUTRAL] OK, I can help you with claim status, [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Policy number for the patient?
[CUSTOMER][NEUTRAL] 018287774.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII].
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Day of service and bill charges.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Date of service [PII] $778 even.
[AGENT][NEUTRAL] Uh, let's see. Well, give me just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] You.
[AGENT][NEUTRAL] It looks like the claim was received [PII].
[AGENT][NEUTRAL] Process 5:[PII].
[AGENT][NEUTRAL] Um, the office visit is not covered under the policy.
[CUSTOMER][NEUTRAL] 298
[AGENT][NEUTRAL] And then the other charge, the benefits were applied to the $1000 calendar year deductible.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. What type of a policy the patient has?
[AGENT][NEUTRAL] This is a secondary policy?
[CUSTOMER][POSITIVE] OK. Secondary and is the what kind of a benefit.
[AGENT][NEUTRAL] You're asking what the benefit is?
[CUSTOMER][NEUTRAL] Yes, what kind of a benefit the patient has, because
[CUSTOMER][NEUTRAL] Of office visit, visits or said is not covered.
[AGENT][NEUTRAL] Well, it's, it's like a, it's a gap policy. So it's like a supplemental policy. It pays after primary pays on certain types of services. Office visits are not one of the services it pays for.
[CUSTOMER][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean, yeah, for this one, can we send an appeal?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] You, you want to send an appeal?
[CUSTOMER][NEUTRAL] Yes, can we send an appeal for this one?
[AGENT][NEUTRAL] Sure, you can. Um, office visits are not covered under the policy though, so there's no reconsidering that, but yes, you can send an appeal if you like.
[CUSTOMER][NEUTRAL] Can I get the address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Is there any fax number?
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is there, what is the timely filing?
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][NEUTRAL] And your name? [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] What is the reference number?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][NEUTRAL] Can you move to the next patient? I do have one more patient.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] 01964143.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] No, is that data service and bill charges?
[CUSTOMER][NEUTRAL] [PII] $335 even.
[AGENT][NEUTRAL] OK, it looks like this policy turned in [PII]. Let me see if there's a different policy.
[AGENT][NEUTRAL] OK, so [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Received on [PII], processed same day.
[AGENT][NEUTRAL] Uh, this policy terminated on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So the patient does not have an active coverage with the APL.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is there any other coverage?
[AGENT][NEUTRAL] Is there any other coverage?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I just show UnitedHealthcare.
[AGENT][NEUTRAL] It's the primary.
[CUSTOMER][NEUTRAL] OK. Thank you. And uh when was the start date and the denied date?
[CUSTOMER][NEUTRAL] Sorry, start date and the end date of the policy.
[AGENT][NEUTRAL] Effective [PII], [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And after that, the policy is not renewed or nothing, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mm, OK, claim number.
[AGENT][NEUTRAL] Plan number is 2093920939.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, for the previous claim, what is the claim number? I didn't get the claim number.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, uh, I'm gonna have to go back to that account. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes. 1, sorry, 01828774.
[AGENT][NEUTRAL] You need the claim number for this claim?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 3604401.
[CUSTOMER][NEUTRAL] 3604401.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much.
[AGENT][NEUTRAL] OK. Do you need the claim number for the other one?
[CUSTOMER][NEUTRAL] Actually, the claim number which you have provided is for which claim?
[AGENT][NEUTRAL] It's, it's the one for the plan that terminated.
[CUSTOMER][NEUTRAL] OK. So 3604401 is for the plan terminated.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Can I get the another claim number?
[AGENT][NEUTRAL] Uh, give me one moment.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] What was the date of service?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] This one's 360-43992.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So far, uh, the patient, [PII], we received a stating it is non-covered services.
[CUSTOMER][NEUTRAL] Is that so?
[AGENT][NEUTRAL] Yes, for the office visit.
[CUSTOMER][NEUTRAL] No, the claim. You said the policy term.
[AGENT][NEUTRAL] Right, yes. I, I, I'm sorry, I'm having a hard time switching back and forth here. So now we're talking about the other policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes 4015.
[AGENT][NEUTRAL] OK, what's your question?
[CUSTOMER][NEUTRAL] Actually, for this policy, the claim number, hm we received the stating it is non-covered, but you are saying the policy term that is the denial.
[AGENT][NEUTRAL] It says the services are rendered after coverage was terminated, non-covered service.
[CUSTOMER][NEUTRAL] Oh, OK. OK, that's it. I get it. Thank you, [PII]. Bye-bye.
[AGENT][POSITIVE] OK, thanks for calling APL. Bye-bye.