AccountId: 011433970860
ContactId: 562c9391-8edc-4aa7-b3b8-ae66eb77c103
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 272420 ms
Total Talk Time (AGENT): 86999 ms
Total Talk Time (CUSTOMER): 137356 ms
Interruptions: 4
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/562c9391-8edc-4aa7-b3b8-ae66eb77c103_20250312T18:21_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling for the provider to check on a claim status. Please note this call will be monitored and recorded for quality and training purposes. How are you doing today?
[AGENT][POSITIVE] I'm good. Can you spell your first name for me?
[CUSTOMER][NEUTRAL] I'm good. Can you spell your first name for me? Uh, sure, it's uh uh sorry, it's [PII]
[AGENT][NEUTRAL] Oh, [PII]?
[CUSTOMER][NEUTRAL] Oh really? Yes.
[AGENT][NEUTRAL] OK, and [PII], did you say you're checking for claim status?
[CUSTOMER][NEUTRAL] And [PII], did you say you're technical claim status? Yes.
[AGENT][NEUTRAL] OK, and if I can get the policy number and a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK, and if I can get the policy number and a good phone number in case we're disconnected. Uh, yes, uh, our phone number is [PII].
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] Uh, sure. It's uh 01807323 M as in Mike, L as in Lima, number 8.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh-huh. Patient's name, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information and um what is the date of service in charge for the claim?
[CUSTOMER][NEUTRAL] Date of service, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And uh total charge, just a moment. Yes, 13.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the uh bill amount is $171 171 dollars.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Uh, sure.
[AGENT][NEUTRAL] OK, so I do show that this claim was received [PII], processed [PII].
[CUSTOMER][NEUTRAL] [PII] process [PII].
[AGENT][NEUTRAL] It looks like the date of service is after the policy uh was no longer active.
[CUSTOMER][NEUTRAL] But the date of services after the policy that was no longer active.
[AGENT][NEUTRAL] I'll give you the claim number and then I'll give you the date the policy was no longer active. Let me know when you're ready.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Yes, I'm ready.
[AGENT][NEUTRAL] OK, so the claim number is 3544.
[CUSTOMER][NEUTRAL] Claim number is 3544.
[AGENT][NEUTRAL] 245
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the policy, um, laps date is [PII].
[CUSTOMER][NEUTRAL] 45
[CUSTOMER][NEUTRAL] And the policy, um, last date is [PII].
[AGENT][NEUTRAL] No active coverage for this patient?
[CUSTOMER][NEUTRAL] You know, access for these patients.
[CUSTOMER][NEUTRAL] Oh, OK. Um, may I know the effective date also?
[AGENT][NEUTRAL] [PII]. I'm sorry, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'm sorry, [PII].
[AGENT][NEUTRAL] Anything else?
[CUSTOMER][NEUTRAL] Oh, [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Correct. Uh, just to confirm, [PII], the member, uh, [PII] on [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Um, so just for a confirmation, the claim was received on [PII], denied on [PII].
[AGENT][POSITIVE] That is correct. Anything else?
[CUSTOMER][NEUTRAL] Uh, can I get the appe mailing address and the timely filing limit also?
[AGENT][NEUTRAL] The timely limit to submit a claim?
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] There's no timely filing limit. The claim is mailing.
[CUSTOMER][NEUTRAL] Oh, the appeal.
[AGENT][NEUTRAL] 180 days from the date of denial.
[CUSTOMER][NEUTRAL] Uh, the time limit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claims mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can I get the call reference number?
[AGENT][NEUTRAL] My name in today's date. First initial last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] the last name is [PII].
[CUSTOMER][POSITIVE] OK. Uh thank you so much and thank you so much for assisting me today. Have a great day and be safe.
[AGENT][POSITIVE] You're welcome, thanks for calling APL [PII]. Have a good day as well.
[CUSTOMER][NEUTRAL] Uh huh bye bye.