AccountId: 011433970860
ContactId: 896f2271-ca52-442f-860d-2cff65b2df8d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 332739 ms
Total Talk Time (AGENT): 111258 ms
Total Talk Time (CUSTOMER): 147946 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/896f2271-ca52-442f-860d-2cff65b2df8d_20250606T16:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, sir. Uh, my name is [PII]. I'm here to check on a claim. Can you help me with that?
[AGENT][POSITIVE] Yep, I'm happy to check on the claim, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Yes, it is D as in Delta 46001308.
[AGENT][NEUTRAL] OK, unfortunately that doesn't come up as a member number that's valid. Do you have their name or social? We can check by that.
[CUSTOMER][NEUTRAL] Yes, I do have the social.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, the social is [PII].
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] What is the patient's first name and then last name?
[CUSTOMER][NEUTRAL] Yes, patient's name is [PII] and uh date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Are you looking for medical or dental coverage today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] medical.
[AGENT][NEUTRAL] OK. So, patient is active. Effective date is [PII]. Did you want the policy number?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK. Policy number is gonna be 02157973.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Was there any other information that you needed?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, I need, I need claim status.
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] And the bill amount.
[CUSTOMER][NEUTRAL] The amount is $2,217.09.
[AGENT][NEUTRAL] Thank you. So claim was received on [PII]. Claim was processed [PII]. There was a benefit payment sent in the amount of $50. This was a single check.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, but we were expecting $2,214.28.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] OK, so this was the maximum benefit for the date of service. There's nothing additional payable on this.
[CUSTOMER][NEUTRAL] OK. Is that, uh, did you verify the uh billing amount?
[AGENT][NEUTRAL] And to build them out
[CUSTOMER][NEUTRAL] Is that the same which I have mentioned to you?
[AGENT][NEUTRAL] The bill amount was for $2,217.09 correct?
[CUSTOMER][NEUTRAL] 2.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So on this claim, that's what we received, yes.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, understood. Can I know.
[CUSTOMER][NEUTRAL] Uh, is there any patient responsibility?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility. That's up to the facility or the provider.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] OK, can I, uh, have an, uh, appeal mailing address so that I can appeal for this.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] let me get that.
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] [PII] understood. Thank you. Is there any timely filing limit to send an appeal?
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] Uh, for an appeal, it needs to be sent with 180 days of the decision.
[CUSTOMER][NEUTRAL] That's.
[CUSTOMER][NEUTRAL] OK. I need to be so.
[CUSTOMER][NEUTRAL] Sure, got that. Can I have the call reference number?
[AGENT][NEUTRAL] Call reference is my name with today's date. My name is [PII], that's [PII], last initial, [PII], and then today's date.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] But that.
[AGENT][NEUTRAL] Anything else?
[CUSTOMER][POSITIVE] Thank you, sir. Uh, that's all for today. Have a nice day.
[AGENT][POSITIVE] OK you too bye bye.
[CUSTOMER][POSITIVE] Nothing else, thank you.