AccountId: 011433970860
ContactId: 5dea6469-3b01-4edc-83ae-e25fc9c03119
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 276980 ms
Total Talk Time (AGENT): 103351 ms
Total Talk Time (CUSTOMER): 161080 ms
Interruptions: 5
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/5dea6469-3b01-4edc-83ae-e25fc9c03119_20250113T17:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. This is [PII]. I'm calling for Ortho LLC. I verified the UB and this call is made for additional information about the denial. Please know the call will be monitored and recorded for quality and training purposes.
[AGENT][NEUTRAL] OK, yeah, I can look at that claims and all for you, [PII]. Um, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] Thank you. And the callback number is [PII] and it is a direct line.
[AGENT][NEUTRAL] Thank you. And then do you have the uh policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I have the claim number and I'm looking for a claim status.
[AGENT][NEUTRAL] OK yeah I can use the claim number that's fine.
[CUSTOMER][NEUTRAL] OK, you want the claim number.
[AGENT][NEUTRAL] That's fine, yeah, I can take that.
[CUSTOMER][NEUTRAL] OK. 3542048.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, um, what was the name and date of birth for the insured [PII]?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The member's name is [PII]. Date of birth is on [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. Give me just a moment.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] All right, so we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Yes, we do have received the, is it on the providers contract?
[AGENT][NEUTRAL] I'm sorry, could you repeat that?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] As you mentioned, we are unable to pay a benefit of uh as offices are not covered. Is it under provider contract?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] No, this is just per their policy.
[CUSTOMER][POSITIVE] OK, thank.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Upon
[CUSTOMER][NEUTRAL] American Public Life Insurance policy, right?
[AGENT][NEUTRAL] Correct, this policy does not cover office visits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you so much for the information.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Could you please uh help me with the apple mailing address?
[AGENT][NEUTRAL] Yeah, mailing address is [PII].
[CUSTOMER][NEUTRAL] that.
[CUSTOMER][NEUTRAL] Today was the.
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] And [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, please give me a quick moment please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Thank you so much for patiently waiting and
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I do have the timely filing limit. Could you please verify it?
[AGENT][NEUTRAL] Um, for an appeal.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That would be 180 days so this claim was processed um [PII], so you're still within that time frame.
[CUSTOMER][NEUTRAL] Oh I was just.
[AGENT][NEUTRAL] We would just need a letter uh stating that it is going to be for an appeal.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] OK. Thank you so much for the information. Could you please help me with the call reference number?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date and so my name is spelled [PII] Oh, is there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] You know, that's all the information I need. Thank you so much for your assistance.
[AGENT][POSITIVE] Of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] I'll.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] OK.