AccountId: 011433970860
ContactId: 3a264b74-a247-4cbe-80b5-fa2bb096140b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 613320 ms
Total Talk Time (AGENT): 200712 ms
Total Talk Time (CUSTOMER): 172080 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/3a264b74-a247-4cbe-80b5-fa2bb096140b_20250403T15:00_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling for Heartland Women's Healthcare Limited to check on additional information. Please be informed that this call is being recorded and monitored for quality and training purposes. May I know if I can help with the patient's information or provider's information?
[AGENT][NEUTRAL] Um, first, can you spell your name for me please and provide a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's uh [PII] and the contact number is [PII].
[CUSTOMER][NEUTRAL] [PII] it's a direct line without extension.
[AGENT][NEUTRAL] Thank you, you said you need clarity on a denial, additional information?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh yes, I have all the information. I just need your we submitted the appeals. I need the appeals document control number and received it and processed it just that that's it.
[AGENT][NEUTRAL] So the appeal status.
[CUSTOMER][NEUTRAL] Right, a status.
[AGENT][NEUTRAL] OK, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] OK, shut up.
[CUSTOMER][NEUTRAL] Member ID is?
[CUSTOMER][NEUTRAL] D as in Delta 434103777.
[AGENT][NEUTRAL] Thank you for that. And do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh yes, I have it.
[AGENT][NEUTRAL] OK, on the ID card, does it say anywhere in hospital or outpatient policy cert number, or it could say policy cert number by itself. It's starting with a 01 or 02?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] No, all I can see the member ID start with the D as in delta.
[AGENT][POSITIVE] Mhm. That's a ninety-degree benefits. Um, I could.
[CUSTOMER][NEUTRAL] OK, the previous
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Sorry, the previous director to me the stays by the name.
[AGENT][NEUTRAL] Yes, that's what I was gonna say. I can search with the first and last name or the social.
[CUSTOMER][NEUTRAL] The first name is [PII].
[AGENT][NEUTRAL] Can you spell the first and last name for me, please?
[CUSTOMER][NEUTRAL] Do you like.
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII], and the last name is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so I believe I just located the policy. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] So [PII].
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] [PII]. All right, thank you so much for verifying and all the information provided is a verification of benefits, not a guarantee of payment.
[AGENT][NEUTRAL] So the policy number is 2381128.
[AGENT][NEUTRAL] And may I have the date of service for the appeal?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And is the claim from [PII] or the spouse?
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And [PII], do you mind if I place you on just a brief hold while I look through the claims?
[CUSTOMER][NEUTRAL] Yeah, sure, please.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes I'm here, uh huh.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The so the appeal, all of the claims that came in after the original claim is denied as a duplicate because we paid out on the original claim. So the last claim that we processed was also denied as a duplicate.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, so the recent most recent uh appeal was red, I have a most recent appeals received it is uh [PII] and it's processed and denied on [PII]. Is that correct?
[AGENT][NEUTRAL] Yes, let me see if this one is yours also. So yes, that was the last that was the last claim process for that data service um received on [PII].
[CUSTOMER][NEUTRAL] Alright, so can you give me your document control number for this?
[AGENT][NEUTRAL] What type of document control number?
[AGENT][NEGATIVE] This isn't, this wasn't listed as an appeal. It was.
[CUSTOMER][NEUTRAL] For a bill?
[CUSTOMER][NEUTRAL] Pro
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] It appeals the document control number.
[AGENT][NEGATIVE] Right, so what I was saying this isn't listed as an appeal. Usually it'll say appeal here. This was just processed as all the others, um, and it was denied as a duplicate 12345, like the other, it was a total of 6 times this has been received.
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright, just give me a moment.
[CUSTOMER][NEUTRAL] OK [PII], so as, uh, let me clarify, the appeal is denied as a duplicate, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So, so you have uh the document control number for that appeal.
[CUSTOMER][NEGATIVE] Which is denied a duplicate. I just need the number.
[AGENT][NEUTRAL] So I understand what you're saying. I, I understand completely. What I'm saying is this claim was not processed as an appeal. It was processed as like another claim that came in. Usually it'll show appeal. It doesn't have that here, so there is no appeal document number. For this claim, it's just the claim number and it was denied as a duplicate of like the other four.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] If you like, I can get a claims examiner on the line to assist you further with the document number, but unfortunately, this was not processed as an appeal.
[CUSTOMER][NEUTRAL] OK, so that's why you don't have a.
[CUSTOMER][NEUTRAL] Uh, document control number correct because this claim is not processed at appeal.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, got it. So all the appeals we submitted is uh process as a claim, correct?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Um, if you're sending, so the, the appeals, well, it goes to IMA, never mind, that's a different one.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Um, yeah, they were all, they were all processed as just claims.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Or is that, can you give me your card reference number?
[AGENT][NEUTRAL] Sure, sir, there's no call reference number, but you can use my name in today's date. And again, that's [PII], first initial to my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] All right. All right, [PII]. Thank you for your assistance. Have a great day ahead.
[AGENT][POSITIVE] You're very welcome [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a great day bye bye.
[CUSTOMER][NEUTRAL] Bye.