AccountId: 011433970860
ContactId: 80cd9504-6a9c-4940-8d09-9a90184f1fa4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 680159 ms
Total Talk Time (AGENT): 221417 ms
Total Talk Time (CUSTOMER): 148110 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/80cd9504-6a9c-4940-8d09-9a90184f1fa4_20250519T18:48_UTC.wav
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[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next available representative.
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good afternoon. Thank you for calling ATO.
[CUSTOMER][NEUTRAL] This is [PII] calling office. Check on your claim status.
[AGENT][NEUTRAL] I'm sorry, I couldn't hardly hear you.
[AGENT][NEUTRAL] Can you repeat what you said?
[CUSTOMER][NEUTRAL] Hello. OK.
[CUSTOMER][NEUTRAL] Hello, can you hear me now?
[AGENT][NEUTRAL] Uh, it's OK.
[CUSTOMER][NEUTRAL] This is [PII]. I'm just looking for the claim status, ma'am.
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] [PII], your voice is going in and out.
[AGENT][NEUTRAL] You're needing a claim status, is that what you said?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, I can help you with claim status. What is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And you have one claim, is that correct?
[CUSTOMER][NEUTRAL] Uh, no, ma'am. I have 2 times.
[AGENT][NEUTRAL] You have 2 claims.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Are they for the same patient or two different patients?
[CUSTOMER][NEUTRAL] Uh, one moment, we'll check that.
[CUSTOMER][NEUTRAL] Just for the different patient, ma'am.
[AGENT][NEUTRAL] OK, so you're gonna use my name [PII] as your call reference number along with today's date for each one. Again my name is [PII].
[AGENT][NEUTRAL] Also, any information that's provided on the claims will be a verification of benefits and not a guarantee of payment. And lastly, if we have the claims on file, [PII], and you need a copy of the explanation of benefits, once I give you the claim number, you can print those by going to our portal at [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what is your first patient's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Z as in Zulu. I'm sorry. The member ID is 0252172.
[AGENT][NEUTRAL] I'm sorry, your voice is fading out again.
[CUSTOMER][NEUTRAL] 02521.
[CUSTOMER][NEUTRAL] 2
[AGENT][NEGATIVE] [PII], your voice is cutting out, and I'm not getting the full number.
[CUSTOMER][NEUTRAL] Hello? Can you hear me, ma'am?
[AGENT][NEUTRAL] I can hear you at the moment. Now, I can hear you at the moment, yes.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] The member ID is 02521722.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] What's, what's the date of birth again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For $277.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was received one moment and I'll provide that information.
[AGENT][NEUTRAL] This claim was received on [PII].
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] It was denied on [PII].
[CUSTOMER][NEGATIVE] Denied.
[AGENT][NEUTRAL] The claim number is 3581055.
[AGENT][NEUTRAL] And the reason for the denial on this claim states that office visits are not covered by the above numbered policy.
[AGENT][NEUTRAL] The member's plan does not cover office visits.
[CUSTOMER][NEUTRAL] Number
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][NEUTRAL] OK. One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What is the plan name, ma'am?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Sorry, can you please repeat the my name?
[AGENT][NEUTRAL] [PII], it is a supplemental policy.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Uh, can I get the billing mailing address for my future reference?
[AGENT][NEUTRAL] Appeal's mailing address is the same as claims, and it must be sent to attention appeals department, and it must be filed within 180 days from the date of the decision.
[CUSTOMER][NEUTRAL] And the address is [PII], and that is that, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Do you have a fax number for a bill?
[AGENT][NEUTRAL] [PII] also attention appeals department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Thank you, ma'am. Can you move on to the
[CUSTOMER][NEUTRAL] Next patient.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And your last patient's policy number?
[CUSTOMER][NEUTRAL] 023
[CUSTOMER][NEUTRAL] 893-887.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] His name is
[CUSTOMER][NEUTRAL] [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount?
[CUSTOMER][NEUTRAL] So 3 22,025 for $58.
[AGENT][NEUTRAL] I'm sorry, what?
[AGENT][NEUTRAL] Say the date again.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, what's the month? I'm not understanding what you're saying, [PII].
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes, ma'am.
[AGENT][NEUTRAL] And the date?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh, and the bill amount.
[CUSTOMER][NEUTRAL] $58.58.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was also received this claim was received on.
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] This claim was received on [PII]. It was denied on [PII].
[CUSTOMER][NEUTRAL] 3:31
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 3128.
[AGENT][NEUTRAL] And the reason for the denial on this claim states, please provide copies of your explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] On
[AGENT][NEUTRAL] We need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Do you have a fax number?
[AGENT][NEUTRAL] The same one that I just gave you.
[CUSTOMER][NEUTRAL] The same one that I just.
[AGENT][NEUTRAL] [PII] attention claims.
[CUSTOMER][NEUTRAL] OK. What is the timely filing limit for submitting the claim in this form of future offense?
[AGENT][NEGATIVE] For the for submitting the explanation of benefits, there is no timely filing limit.
[CUSTOMER][NEUTRAL] No, ma'am, I'm just asking for a future reference. I just need the, uh, timely filing for claim.
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] Oh, you're welcome. Is there anything else, [PII] I can help you with today?
[CUSTOMER][POSITIVE] Nothing, ma'am. Nothing else. Thank you so much for the information.
[AGENT][POSITIVE] Well, you're very welcome and thank you for calling APL. I hope you have a very nice day.
[CUSTOMER][POSITIVE] Have a very nice day. Yeah. You too.
[AGENT][POSITIVE] Uh, thank you very much. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.