AccountId: 011433970860
ContactId: 5a6e1ffa-f3b0-47e9-8703-28e23d9974a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 412549 ms
Total Talk Time (AGENT): 107643 ms
Total Talk Time (CUSTOMER): 127095 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/5a6e1ffa-f3b0-47e9-8703-28e23d9974a7_20250324T17:06_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII]. I'm calling from provider office. I'm checking on claim status.
[AGENT][POSITIVE] I'd be happy to assist with claim status. Can you pronounce your name for me again, please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]
[AGENT][NEUTRAL] Oh, [PII], I'm sorry, and [PII], if I can get a good call back number for you?
[CUSTOMER][NEUTRAL] Sure, ma'am. It's uh [PII]. Uh just a second.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, it's uh [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 83401.
[AGENT][NEUTRAL] That
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What's the patient's name?
[CUSTOMER][NEUTRAL] Uh, patient name is [PII].
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what type of
[AGENT][NEUTRAL] It looks like this is a
[AGENT][NEUTRAL] Cancer policy.
[AGENT][NEUTRAL] Um, and what's the date of service?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, ma'am. It's uh [PII].
[AGENT][NEUTRAL] I'm not sure we have a claim on file for [PII].
[CUSTOMER][NEUTRAL] OK, ma'am. Uh, we have tried, uh, multiple times to submit a claim to you, but, uh, I don't know why, uh, this claim is not getting on file. Can you please, uh, like verify me the mailing address?
[AGENT][NEUTRAL] What's the tax ID?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, the tax ID is [PII].
[AGENT][NEUTRAL] OK. I'm sorry. I do see it.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] So it looks like this claim was submitted.
[AGENT][NEUTRAL] More than one time, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the initial claim.
[AGENT][NEUTRAL] It was received on [PII], claim denied on [PII] because any condition other than cancer is not covered since this is a cancer policy.
[CUSTOMER][NEUTRAL] OK, ma'am. Just a second.
[CUSTOMER][NEUTRAL] Uh, so, like, uh, uh, this policy does not, uh, follow the Medicare guidelines because, uh, patient has in, uh, Medicare as primary and they have, uh, like already paid for the claim.
[AGENT][NEGATIVE] This is a cancer policy. So it's not a, we're, it's not a major medical policy or it's not a gap policy, it's just a cancer policy. So it does not cover anything that's not a cancer diagnosis. That's why the claim denied.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right, ma'am. Can you please provide me the claim number?
[AGENT][NEUTRAL] Claim number is 356-860-5.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 256-8605
[CUSTOMER][NEUTRAL] All right. And uh can you send me the copy of EOB to our fax number?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] What's the fax number?
[CUSTOMER][NEUTRAL] Yeah, just a second.
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] [PII] I'm sorry [PII].
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] [PII]. That's correct.
[AGENT][NEUTRAL] Alright, you should receive that fax by the close of business today. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] Yes, ma'am. That's uh there are 2 data service mode for this patient, for the same patient.
[CUSTOMER][NEUTRAL] And I think uh that could be had been denied for the same, yeah. So it's uh [PII].
[AGENT][NEUTRAL] Data service?
[AGENT][NEGATIVE] Yeah, I'm showing it's the same denial.
[CUSTOMER][NEUTRAL] OK. You can provide me the claim number and send the copy of your with our fax. That's it.
[AGENT][NEUTRAL] Claim number is 35547777.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. Do you need the fax number again?
[AGENT][NEUTRAL] No, I don't need the fax number. I need the, the next state of service.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, I'm showing the same.
[AGENT][NEUTRAL] Same denial, claim number is 3554783.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right, ma'am. Thank you for that. And uh what is the time if I limit uh to submit a claim, uh, in general?
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][NEUTRAL] All right. And what will be the reference number for this call?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Uh, no, sir. Thanks, uh, for that, and that's it for today. Thank you for your help.
[AGENT][POSITIVE] Thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] You too, ma'am bye.