AccountId: 011433970860
ContactId: 7a2bd982-2b69-4fe3-a6ea-4ba3b3b15fa9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 350309 ms
Total Talk Time (AGENT): 101639 ms
Total Talk Time (CUSTOMER): 116957 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/7a2bd982-2b69-4fe3-a6ea-4ba3b3b15fa9_20250108T21:53_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 from the provider's office looking for the claims.
[AGENT][NEUTRAL] OK, yeah, I can check on a claim for you [PII]. Uh, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm. And the callback number [PII] is the direct line.
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Mhm, yeah, one moment.
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sorry for the delay. One moment.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Give me the number
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No chewing the.
[CUSTOMER][NEUTRAL] Yeah, the member ID?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 02137805
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] The patient first name is [PII], the last name [PII]. There of birth on [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that then and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Mhm, yeah, the date of service on uh [PII], the total amount $189. 20 cents.
[AGENT][NEUTRAL] $189.20.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] I'm sorry, [PII], what was the name of the uh provider's office?
[CUSTOMER][NEUTRAL] Mhm. Yeah. And uh
[CUSTOMER][NEUTRAL] It's Palmatopolyacry group of Anderson.
[AGENT][NEUTRAL] OK perfect thank you for verifying that. I did find this claim uh we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. So for this one, previously we got the payments of the previous little service on [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, one, OK, 1.
[CUSTOMER][NEUTRAL] So it was as a non-covered, right? As a patient plan.
[AGENT][POSITIVE] That's correct. Correct.
[CUSTOMER][NEUTRAL] When the patient plan name?
[AGENT][NEUTRAL] Uh yeah, it's a secondary medical policy. The plan name is Medlik, M E B L I N K.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. And may I know the mailing address?
[AGENT][NEUTRAL] Yes, our mailing address is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] And the [PII] and can you please spell it?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] And can you please spell on?
[AGENT][NEUTRAL] Sure. [PII], that's [PII]
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] May I know the time frame limit to submit air?
[AGENT][NEUTRAL] Um, appeals are within 180 days, so this would be outside of that time frame.
[CUSTOMER][POSITIVE] Mm thank you.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] And may I know the quality difference?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date and so my name is spelled [PII], last initial is [PII]
[AGENT][NEUTRAL] Was there anything else I can help you with [PII]?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Yeah, no, that's fine, [PII]. Have nice to talk to you. Have a nice day. safe. Bye.
[AGENT][POSITIVE] Of course, thanks for calling APL you too thank you bye bye.