AccountId: 011433970860
ContactId: 8cfd7fca-1340-47d5-a0fd-bb485c591fa8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 359859 ms
Total Talk Time (AGENT): 92689 ms
Total Talk Time (CUSTOMER): 70527 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/8cfd7fca-1340-47d5-a0fd-bb485c591fa8_20250514T13:10_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], good morning. This is [PII] calling from doctor's office calling to check a claim for a member.
[AGENT][POSITIVE] All right. I'm happy to check on a claim for you. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Sure, it is going to be 02424884 M Mary L Lima 8.
[AGENT][NEUTRAL] Thank you. And then if I could get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][NEUTRAL] Thank you. And then what is the date of service?
[CUSTOMER][NEUTRAL] It's [PII] with the total bill amount of $215.14.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][POSITIVE] Thank you for your patience on that. So we did receive a claim for the state of service on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was denied [PII]. Office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] Uh, yes, actually we did submit an appeal along with the medical records on [PII] via fax. Can you please check if you, uh, what's the status of it?
[AGENT][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment, just pulling this up here.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] it
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Why didn't want [PII] in the mic.
[CUSTOMER][NEUTRAL] No, sir, are you still there?
[AGENT][NEUTRAL] Yeah, I'm still here. I do see that the appeal was received. I'm trying to see what the decision was on it here, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And meanwhile can you let me know when was it received and processed on?
[AGENT][NEUTRAL] Uh, I show a receival date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it looks like uh.
[AGENT][NEUTRAL] I'm trying to see if they've already made a decision on it, so bear with me one moment.
[AGENT][NEUTRAL] It looks like the appeal is still under decision under review so no decision has been made.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Because it's almost more than 2 months I guess.
[CUSTOMER][NEUTRAL] Is there any delay reason?
[AGENT][NEUTRAL] It's not showing any decision or any reasoning, just that it's still under review at this time.
[CUSTOMER][NEUTRAL] And how many days should you have?
[AGENT][NEUTRAL] I'm sorry, what was that again?
[CUSTOMER][NEUTRAL] How many, how many days should be allowed to process this appeal?
[AGENT][NEUTRAL] You can, you can check back within 7 days if you would like.
[CUSTOMER][NEUTRAL] Alright, sir, may I have the call reference number please for this member?
[AGENT][NEUTRAL] You can use my name with my last initial in today's date. My name is [PII], last initial [PII], then today's date.
[CUSTOMER][NEUTRAL] And do you have any document number uh control number for this member for the appeal.
[AGENT][NEUTRAL] 357.
[CUSTOMER][NEUTRAL] 357
[AGENT][NEUTRAL] 3982.
[CUSTOMER][POSITIVE] All right thank you.
[AGENT][NEUTRAL] You're welcome. Anything else?
[CUSTOMER][NEUTRAL] Nothing else thank you bye.
[AGENT][POSITIVE] You're welcome bye bye.
[CUSTOMER][NEUTRAL] Uh,