AccountId: 011433970860
ContactId: 3c02c79f-5ac9-4a43-8300-7d2c1e24a586
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 403970 ms
Total Talk Time (AGENT): 161217 ms
Total Talk Time (CUSTOMER): 180462 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/3c02c79f-5ac9-4a43-8300-7d2c1e24a586_20250317T17:19_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm [PII]. I'm calling from the provider's office. I'm here to check on your claim status. Could you please assist me with that for today?
[AGENT][POSITIVE] Yeah, I'd love to help you, Miss [PII], and we're gonna check on a claim status. Do you mind real quick though if I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm, the callback number is [PII].
[CUSTOMER][NEUTRAL] I'm sorry, it is, let me start over. It's [PII]. Could you please spell out your good name for the accommodation?
[AGENT][NEUTRAL] Oh, you betcha. It's [PII], first initial, last name, [PII].
[CUSTOMER][POSITIVE] Mhm thank you so much.
[AGENT][POSITIVE] My pleasure, Miss [PII], and can I have that policy number when you're ready?
[CUSTOMER][NEUTRAL] Yes, sure. The policy number is D as in Delta 437,301,160.
[AGENT][NEUTRAL] OK, um, that policy number is going to be the policy number for 90 degree benefits but not for us with APL. Do you have another one on the card that's 6 to 8 digits and starts with a 0 or a 1 or 2?
[CUSTOMER][NEUTRAL] Just give me one quick moment here.
[AGENT][POSITIVE] OK, take your time.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Thank you so much for being on hold, but upon checking here, I don't have that member ID, but could you please check with the patient's first name and last name?
[AGENT][NEUTRAL] Yes, I can search for their.
[CUSTOMER][NEUTRAL] Because I do have a claim number that belongs to this one. Uh-huh.
[AGENT][NEUTRAL] Oh, if you have the claim number I can just pull it up with that. What's that number, my friend?
[CUSTOMER][POSITIVE] Yeah, thank you so much. And the claim number I have here is
[CUSTOMER][NEUTRAL] 352-589-0
[AGENT][NEUTRAL] 90. OK. Give me just a couple moments, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Would you be able to please verify your insured's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. It is [PII]. And the date of birth is [PII].
[AGENT][POSITIVE] OK, wonderful. Thank you. And again, just another second. I do have that policy number though if you'd like it for your records.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Perfect. And I have that number listed as 2462731.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that would be the correct policy number, right? Mhm.
[AGENT][NEUTRAL] All right, yes.
[AGENT][NEUTRAL] Yes, that's gonna be that policy number for us, and I'm just gonna have you verify um if you can, the name of the provider on that claim.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] So the name of the provider is [PII].
[AGENT][NEUTRAL] Oh, I'm sorry, the facility name. I should have said that. I'm sorry.
[CUSTOMER][NEUTRAL] OK. That's OK. Uh, the facility name is Radiology Associates of Northern Kentucky.
[AGENT][POSITIVE] Wonderful. Perfect. So, I'm looking at this um claim for you and it does look like it was denied. I'm showing here that the maximum benefit for diagnostics has been met for the calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So it looks like.
[CUSTOMER][NEUTRAL] Mhm. So,
[CUSTOMER][NEUTRAL] Yeah, I'm sorry for that one. So for that one, we have submitted the medical records and the appeal on [PII] and I'm here to check if you have received any appeal.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK, and you mailed the appeal to us at the PO box mailing address?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] No, we have actually faxed the appeal and I do have a fax number here on which we have done the process. So let me help you with the fax number. So could you please verify if this fax number is correct? The fax number that we have sent, uh-huh, the fax number that we have submitted the appeal is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, I can verify.
[AGENT][NEUTRAL] OK, so we will actually um we'll want that to a different number if that's OK.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEGATIVE] Yeah, so this is not the correct fax number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, my friend, I'm sorry.
[CUSTOMER][NEUTRAL] [PII], that's OK.
[AGENT][NEUTRAL] OK, so it looks like.
[CUSTOMER][NEUTRAL] So, could you please help me out to the correct fax number? Mhm.
[AGENT][NEUTRAL] Yeah, you're gonna wanna send that to [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] and you'll make it attention APL appeal department.
[CUSTOMER][NEUTRAL] OK. So could you please also help me out with the mailing address just to take a note of that one.
[AGENT][NEUTRAL] Yes, the mailing address you'll send is to [PII]. That's in [PII].
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. So the timely filing limit to submit an appeal?
[AGENT][NEUTRAL] Um, it's 180 days after the decision was made, so it looks like 6 months from [PII], and so you should still have some time.
[CUSTOMER][POSITIVE] Mhm. Yeah, thank you so much for that money.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Just give me one more quick moment here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Yeah, and thank you so much for being on a quick hold. So for this, uh, claim that which ends with 5890, there is no billed consultation on file because the fax number is incorrect. So we have to resubmit that again. Is that correct? Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much. Could you please also help me out with the call reference number for our conversation?
[AGENT][NEUTRAL] You bet you the reference number, it's just my name [PII], first initial, last name, [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you so much for that one and thank you so much for your assistance as well. Take care and stay safe. Bye for now.
[AGENT][POSITIVE] Hey my pleasure you too bye bye.
[CUSTOMER][NEUTRAL] Mhm.