AccountId: 011433970860
ContactId: 501607e5-6840-4748-b900-ce61d177efa6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 593440 ms
Total Talk Time (AGENT): 221923 ms
Total Talk Time (CUSTOMER): 131812 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/501607e5-6840-4748-b900-ce61d177efa6_20250219T14:21_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hello, I'm [PII]. My is [PII] like I go calls regarding claims. Could you please help me with that?
[AGENT][NEUTRAL] I yeah, I can barely hear you.
[CUSTOMER][NEUTRAL] I'm audible.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Have I go now?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Yes ma'am, I can hear you a little better now and who am I speaking with again?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh yes, my name is [PII]. My initial E like echo calls regarding claims. Could you please help me with that?
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes. Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] How many claims do you have to check status on?
[CUSTOMER][NEUTRAL] Uh, it's 1
[CUSTOMER][NEUTRAL] Oh, it's 2 glimps.
[AGENT][NEUTRAL] Did you
[AGENT][NEUTRAL] OK. Are the two claims for the same patient or two different patients?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Uh, different patients.
[AGENT][NEUTRAL] OK, so [PII], you will use my name that I gave you as your call reference number along with today's date for each one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Also, any information that I provide for you on either claim will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And lastly [PII], if we do have the claims on file and you need a copy of either explanation of benefits, you may print them directly from our portal by going to secured.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] [PII]. But yes, ma'am, I can help you with claim status. And what is the first patient's policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, it's 01660281, M as in Mary, L as in Lima, and the number 7.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Just a moment, [PII] while my information is still populating.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and again, uh, any information provided on the claims today would be a verification of benefits and not a guarantee of payment. What is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yes. Patient's name, [PII].
[AGENT][NEUTRAL] Their date of birth?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] Uh, it's [PII] $45.53.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK just one moment please.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[AGENT][NEUTRAL] It was processed and denied on 8-27-2024.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3497742.
[AGENT][NEUTRAL] And the reason for the denial on this claim states policy provides no benefits for the treatment of conditions other than a sickness or injury as defined by the policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, is it provided in network or out of network?
[AGENT][NEUTRAL] There is no network with the supplemental policy. This is not her primary insurance. This is a supplemental plan to her primary insurance.
[CUSTOMER][NEUTRAL] Mm, got it.
[CUSTOMER][NEUTRAL] May I know the time to filing for security claim?
[AGENT][NEGATIVE] There is no timely filing limit?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And an appeal must be solved within 180 days from the date of a decision.
[CUSTOMER][NEUTRAL] Mm, got it. Just a moment.
[AGENT][NEUTRAL] And it would need to be sent to attention our same mailing addresses claims attention appeals department.
[CUSTOMER][POSITIVE] Yes, got it. Just give me a moment.
[CUSTOMER][NEUTRAL] Uh yes, I do have one more claim with a different member ID. Could you please help me with that?
[AGENT][NEUTRAL] OK, so this is all of the information that you needed on this number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And what is your next patient's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Uh yes. It's 01742615.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And your patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, it's called [PII], [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the date of service and total bill amount for him please.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] [PII] $131 even.
[AGENT][NEUTRAL] 131. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] I hope.
[AGENT][NEUTRAL] OK, so this claim was also received.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, I'm not
[AGENT][NEUTRAL] And the claim number for this is going to be, uh it was received on 85-2024 processed and denied on 88.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 2024.
[AGENT][NEUTRAL] The claim number is 349-0203.
[AGENT][NEUTRAL] And the reason for the denial on this claim, office visits are not covered by the above numbered policy. The members supplemental plan does not cover office visits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Got it. When was your claim processed?
[AGENT][NEUTRAL] Let me go back and give you that information again.
[AGENT][NEUTRAL] Again, the, the claim was processed on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Go.
[CUSTOMER][NEUTRAL] Yeah, you said the call reference number with your name and today's date, is that correct?
[AGENT][POSITIVE] Yes, ma'am, that is correct.
[CUSTOMER][POSITIVE] Got it. Thank you so much for your assistance. Hope you have a good day. Bye-bye.
[AGENT][POSITIVE] Well, you're certainly do yes ma'am. You too. That's all I can help you with. Thank you again for calling APL today, [PII].
[CUSTOMER][NEUTRAL] Yeah