AccountId: 011433970860
ContactId: 86f40f71-0edb-4419-a2df-9555d6fd90e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 444920 ms
Total Talk Time (AGENT): 136782 ms
Total Talk Time (CUSTOMER): 117223 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/86f40f71-0edb-4419-a2df-9555d6fd90e6_20250304T15:57_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning, and this is [PII]. My last initial is [PII], and I'm calling from uh Labor billing department, and this call will be recorded for training and quality purposes, and I'm calling about the claim status for one patient. And may I ask your assistance with this?
[AGENT][NEUTRAL] Sure, Ms. [PII], I can assist you with claim status, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] And our best callback number is [PII] and it's a direct call.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] The policy number is 02546253.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] May I have, bear with me just a second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name is [PII] and for the date of birth is [PII].
[AGENT][NEUTRAL] OK, it's gonna be hard. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] For the date of service on [PII] with a total the amount of $791.70.
[AGENT][NEUTRAL] OK. [PII], the amount of $791.70. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right. Let me see if I can find this claim and for future, you can check claim status online through our website at [PII], and that's just optional.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Right, let me pull this AOB. Let me see if this is your claim. One moment.
[AGENT][NEUTRAL] Be waiting one moment.
[CUSTOMER][POSITIVE] Mhm, sure it's a good time.
[AGENT][NEUTRAL] All right. It looks like we processed this claim [PII] and the claim was denied. Um, the denial reason is, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On the calendar, your maximum for the wellness benefits has been met for the calendar year.
[CUSTOMER][NEUTRAL] And what we need to submit in order for us to process again this claim?
[AGENT][NEUTRAL] Um, you have, um, the right to appeal because it's already been processed and denied. The appealing time is 180 days from the decision date, which, um, the decision date was [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] [PII], let me go back to it. [PII].
[CUSTOMER][NEUTRAL] Mhm. OK, thank you so much. And also may I know where we need to submit this claim? Is that through fax number or claim address?
[AGENT][NEUTRAL] OK, you can either fax it or mail it. If you're gonna fax it, the fax number is [PII].
[AGENT][NEUTRAL] If you're gonna mail it, it's gonna be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I just want to confirm if I got it correctly. This claim was denied due to maximum limit and they the calendar year. We need to submit an appeal. Uh, the time the filing limit is 180 days from the decision reach, which is the [PII], and the fax number is [PII].
[CUSTOMER][NEUTRAL] 3659423 and the claim address is [PII] [PII], [PII]. The zip code is [PII], right?
[AGENT][NEUTRAL] Um, yes, now, the denial reason is the benefit has been exhausted for the calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And also may I know the call reference number for this call?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] And also may I know your first name as well as your initial of your last name?
[AGENT][NEUTRAL] My first name is [PII]. That's [PII]. Last initial is [PII].
[CUSTOMER][POSITIVE] OK, got it, and I got all the information. Thank you so much for helping me and have a good one.
[AGENT][NEUTRAL] Hm
[AGENT][POSITIVE] You're welcome you as well, and thank you for calling APL. Have a good day, Miss [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Yes sir bye bye.