AccountId: 011433970860
ContactId: 901766a1-cc84-4d65-8a4b-daa77cec5097
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 382660 ms
Total Talk Time (AGENT): 87083 ms
Total Talk Time (CUSTOMER): 169577 ms
Interruptions: 4
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/901766a1-cc84-4d65-8a4b-daa77cec5097_20250612T16:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, hi, [PII]. This is [PII] calling from provider's office.
[AGENT][NEUTRAL] OK. How can I help you, [PII]?
[CUSTOMER][NEUTRAL] Yeah, I'm looking on games here.
[AGENT][NEUTRAL] You're needing claim status?
[CUSTOMER][NEUTRAL] Let
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the policy number for the patient?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 025
[CUSTOMER][NEUTRAL] 79983.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] First name of the member will be [PII]. Last name will be, it would be clear. Date of birth would be [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the date of service and bill charges?
[CUSTOMER][NEUTRAL] Later service.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Total charge amount is $542 even.
[AGENT][NEUTRAL] OK, looks like we received the claim on 41-2025.
[CUSTOMER][NEUTRAL] Just a month, sir. Could you please spell out your name for me?
[AGENT][NEUTRAL] [PII], it's [PII]
[CUSTOMER][NEUTRAL] Last name [PII]. Thank you. Go ahead, please.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Claim was received.
[AGENT][NEUTRAL] Claim was received on 41-2025, process 44-2025.
[AGENT][NEUTRAL] Office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] Processed.
[CUSTOMER][NEUTRAL] Fine, fine. Received in [PII] [PII] or [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And Ross is [PII], right? OK. And uh OK, status will be?
[AGENT][NEUTRAL] The claim was denied for office visits not covered under the policy.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] The night for all.
[CUSTOMER][NEUTRAL] Or is it's not covered on the policy.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] B R N D
[CUSTOMER][NEUTRAL] Remember ID is Y as in.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] When it was denied on the date of [PII], right? [PII].
[AGENT][NEUTRAL] Yes, it's processed on [PII] denial is sent.
[CUSTOMER][NEUTRAL] D
[CUSTOMER][NEUTRAL] It'll be the same date, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so what is the resolution for this?
[AGENT][NEUTRAL] What is the what?
[CUSTOMER][NEUTRAL] I think what can we do for us?
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] it's not covered under the policy, so there's no coverage for office visits under the policy?
[CUSTOMER][NEUTRAL] OK. Could you please let me know the claim number?
[AGENT][NEUTRAL] Claim number 3585059.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is that the claim number or is there any other?
[AGENT][NEUTRAL] That that's it.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, fine. I would like to verify whether it is 3585059. Let me know what can we do for this.
[AGENT][NEUTRAL] I, I don't, I mean, it's not covered under the policy. It's not a covered benefit. Are you, you can appeal it if that's what you want to do. It's just not a covered benefit under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Could you please let me know the the family saling limit?
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] P M A.
[AGENT][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes, please. Y as in D as in Delta. D as in Delta.
[CUSTOMER][NEUTRAL] A time limit.
[AGENT][NEGATIVE] There is no timely filing limit.
[AGENT][NEUTRAL] The appeals filing limit is that what you're saying?
[CUSTOMER][NEUTRAL] Yeah, as you have stated, we need to submit an appeal, right? Let me know the appeals can selling limit to submit an.
[AGENT][NEUTRAL] It's 180 days from the date of service process.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 180 days.
[CUSTOMER][NEUTRAL] On the date of
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Call reference number for this call.
[AGENT][NEUTRAL] It's my name is [PII] and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, let me confirm the claim number, whether it is 3585058.
[CUSTOMER][POSITIVE] 18. 5059. OK, fine. Thank you so much for that.
[AGENT][NEUTRAL] 3585059.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for that. Have a great day.
[AGENT][POSITIVE] Thank you for calling APL. You as well. Bye-bye.