AccountId: 011433970860
ContactId: 6f1fe859-00be-4b2a-9c23-8555f94dc0f7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 558780 ms
Total Talk Time (AGENT): 167540 ms
Total Talk Time (CUSTOMER): 124316 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/6f1fe859-00be-4b2a-9c23-8555f94dc0f7_20250527T20:44_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 the provider's office to check on the clarification of a claim. So please do know that this call will be monitored and recorded for quality and training purposes.
[AGENT][NEUTRAL] OK [PII], can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, it is [PII] it is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and I can help you with claim status. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, it is 0256.
[CUSTOMER][NEUTRAL] 4543
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, number 8.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the date of birth, [PII].
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, but I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] And do you have the date of service or the claim number?
[CUSTOMER][NEUTRAL] Well yeah
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[CUSTOMER][NEUTRAL] Why you
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] 692 of 1994.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] A
[AGENT][NEUTRAL] And do you have the total bill amount?
[CUSTOMER][NEUTRAL] Yeah, that's $308 even.
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] I'm showing that we received that claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] Claim number
[AGENT][NEUTRAL] 35
[AGENT][NEUTRAL] 98426.
[AGENT][NEUTRAL] And that claim was denied because the data service was after the policy has lapsed.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So this policy lapsed on [PII].
[CUSTOMER][NEUTRAL] May I know when the policy started, effective date?
[AGENT][NEUTRAL] The effective date was [PII].
[CUSTOMER][NEUTRAL] So the member doesn't have any other active coverage during a sales, right?
[AGENT][NEUTRAL] Right, there's no other active policies with us and the date of service was after the policy was no longer effective.
[CUSTOMER][NEUTRAL] And then now, I have one more claim with a different member regarding the same denials. So could you please help me with that too?
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me close this one real quick.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] I'm almost done give me just one more moment.
[CUSTOMER][NEUTRAL] Mo
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What's the other policy number?
[CUSTOMER][NEUTRAL] 109
[CUSTOMER][NEUTRAL] 323
[CUSTOMER][NEUTRAL] I'm sorry, I'm sorry for that. I'm really sorry. So the policy number is going to be?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh. It is 023.
[CUSTOMER][NEUTRAL] 10891
[CUSTOMER][NEUTRAL] M Mike L Lima, number 8.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII], and the date of birth, [PII].
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And what was the date of service or the claim number for this one?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The date of service, [PII].
[CUSTOMER][NEUTRAL] And the total charge is $729 even.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] You said [PII], correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, I'm showing we received that claim on [PII]. It was processed on [PII], I'm sorry, [PII].
[AGENT][NEUTRAL] Claim number is 35.
[AGENT][NEUTRAL] 96957.
[AGENT][NEUTRAL] And that claim was denied due to office visits not being covered.
[CUSTOMER][NEUTRAL] Is this office is not covered under the patient's plan or provider's contact?
[AGENT][NEGATIVE] Office visits aren't, um, aren't covered under her policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What about the remaining address?
[AGENT][NEUTRAL] Our mailing address?
[CUSTOMER][NEUTRAL] No, appeal's mailing address.
[AGENT][NEUTRAL] Oh, appeals? OK, give me just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You'll put APL attention appeal department.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] In [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And Apple family policy limit?
[AGENT][NEUTRAL] For appeals, you'll need to wait 180 days after the receipt of notice saying that they were um denied.
[AGENT][NEUTRAL] So 180 days from the [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So that's for today's call here, [PII]. You can just go on with the call reference number.
[AGENT][NEUTRAL] We don't have call reference numbers, but you can use my name and last initial in today's date, so [PII] and today's date.
[CUSTOMER][POSITIVE] OK, so that's what this call you [PII]. Thank you for information of your assistance. Have a nice day.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.