AccountId: 011433970860
ContactId: 6aaeb2eb-5ab5-4632-80cb-d71fb42083ca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 289950 ms
Total Talk Time (AGENT): 110425 ms
Total Talk Time (CUSTOMER): 85916 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/6aaeb2eb-5ab5-4632-80cb-d71fb42083ca_20250227T17:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] from the provider office checking on the appeal status.
[AGENT][NEUTRAL] I'm sorry, we need to check on a claim.
[CUSTOMER][NEUTRAL] Appeal, yes, on the claim appeal status.
[AGENT][NEUTRAL] OK, I can check on a claim for you and you said your name was [PII]?
[CUSTOMER][NEUTRAL] Yes. Could you spell your name for me, please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] and then [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh sure. [PII], and it's a direct line.
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Oh yeah, I do. The member ID is 021.
[CUSTOMER][NEUTRAL] 20091 M as in Mary, L as in Lima, number 7.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] My my name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, and then uh what was the date of service for this claim, please?
[CUSTOMER][NEUTRAL] Date of services [PII].
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and that build them out please.
[CUSTOMER][NEUTRAL] The amount is $303 even that is 303.
[AGENT][POSITIVE] Got it. Thank you. One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry, [PII], what was the name of the provider's office this was with?
[CUSTOMER][NEUTRAL] Florida Women Care LLC.
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] OK, so we did receive this claim, uh, we were unable to pay a benefit as per this policy, the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Yeah, we have submitted an appeal on [PII] through fax. I'm checking on that.
[AGENT][NEUTRAL] OK, when was that sent? I'm sorry.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Sorry, [PII].
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] All right, bear with me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm not showing that we've received anything. You said, uh, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm not showing that we've received that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, can you verify the fax number? The fax number is [PII].
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And for an appeal we would have to have um.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] A letter of course stating that it is for an appeal.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Also, the timely filing for an appeal is within 180 days of the original claims process date, and this claim was processed [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have the call reference number of yours? And before that, can I have the mailing address?
[AGENT][NEUTRAL] Yes, mailing address is [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm thank you. Can I have the call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] And was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] I know that's it for now. Thank you. Have a great day, [PII].
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye bye.