AccountId: 011433970860
ContactId: 6bf182bd-0c1f-4b5f-8a45-bf166e552afd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 426760 ms
Total Talk Time (AGENT): 159871 ms
Total Talk Time (CUSTOMER): 112763 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/6bf182bd-0c1f-4b5f-8a45-bf166e552afd_20250508T12:50_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I am [PII] calling from provider's office to account in a claim status.
[AGENT][NEUTRAL] I'm sorry, [PII], I can hardly hear you.
[CUSTOMER][NEUTRAL] OK. I'm [PII] calling from provider's office to account deni claim status.
[AGENT][NEUTRAL] You're calling for denied claim status, is that correct?
[CUSTOMER][POSITIVE] Yes. Yes, correct.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][NEUTRAL] OK, [PII], you broke up. I heard [PII]. And then what's after the [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Extension
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII] is correct.
[AGENT][NEUTRAL] Thank you. And the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] Yes, it is 02283844. M as in Mike, L Lima, number 7.
[AGENT][POSITIVE] Thank you, one moment please.
[AGENT][NEUTRAL] And any information provided will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] This is 4.
[CUSTOMER][NEUTRAL] Uh, give me a moment.
[CUSTOMER][NEUTRAL] $235 even.
[AGENT][NEUTRAL] 235. Is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And do you already have the claim number?
[CUSTOMER][NEUTRAL] Uh huh, give me a moment.
[CUSTOMER][NEUTRAL] No. Could you please provide me the claim number?
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] This claim was received on [PII], denied on [PII].
[AGENT][NEUTRAL] The claim number is 3593052.
[AGENT][NEUTRAL] And the denial remark.
[CUSTOMER][NEUTRAL] Could you please repeat one? Just for a second, just for a second. Could you please repeat first? OK.
[AGENT][NEUTRAL] 359.
[AGENT][NEUTRAL] The claim number is 3593052.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the reason for the denial on here states durable medical equipment, DME is not covered under this policy.
[AGENT][NEUTRAL] The member's plan. Correct. The member's plan does not cover DME.
[CUSTOMER][NEUTRAL] DM mean not covered under.
[AGENT][NEUTRAL] And if you need a
[CUSTOMER][NEUTRAL] May I know the members
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] Member's plan.
[AGENT][NEUTRAL] This is a supplemental policy called Medlik.
[CUSTOMER][NEUTRAL] So, supplemental?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Supplemental plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Did you accept appeal for this type of claims?
[AGENT][NEUTRAL] An appeal must be filed within 180 days from the date of the decision.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] To
[AGENT][NEUTRAL] Correct, and it must be sent to attention appeals department.
[AGENT][NEUTRAL] To the same address as claims.
[CUSTOMER][NEUTRAL] Just give me a moment.
[CUSTOMER][NEUTRAL] OK. Just give me a moment.
[CUSTOMER][NEUTRAL] I want to check something, just for a second.
[CUSTOMER][NEUTRAL] 180 days, right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And it must be sent to attention appeals department.
[CUSTOMER][NEUTRAL] To the attention to
[AGENT][NEUTRAL] Appeals department.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits with the remark that I read to you, you may print that yourself by going to.
[CUSTOMER][NEUTRAL] And this plan type is uh
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, I have this one.
[AGENT][NEUTRAL] Oh, you had said you didn't have the claim number, OK, but we do have that portal at [PII] should you need to utilize that.
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK, thank you, thank you so much. This plan type is supplemental policy, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Could you please spell out your name?
[AGENT][NEUTRAL] [PII] first initial to last name [PII], and my name in today's date will be your call reference number.
[AGENT][NEUTRAL] And is there anything else, [PII], I can help you with today?
[CUSTOMER][NEUTRAL] Apple is 180 days from date of or date of service.
[AGENT][NEUTRAL] Date of denial.
[CUSTOMER][POSITIVE] OK. Thank you, thank you so much, ma'am.
[AGENT][POSITIVE] OK, well, if that's all I can help you with, thank you again for calling APO and I hope you have a nice day.
[CUSTOMER][POSITIVE] Thank you, thank you so much. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye bye.