AccountId: 011433970860
ContactId: 93678522-d1ae-4e43-b385-78bd56982ad1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 438579 ms
Total Talk Time (AGENT): 127627 ms
Total Talk Time (CUSTOMER): 170211 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/93678522-d1ae-4e43-b385-78bd56982ad1_20250624T21:49_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes. Hi, my name is [PII] calling from Toyota's office to check on your status for claims. Could you please assist?
[AGENT][NEUTRAL] OK, we're needing to check on the appeal.
[CUSTOMER][NEUTRAL] Yes, AP status, yes, for claims.
[AGENT][POSITIVE] Sure, got it, yeah, I can check that for you. uh, [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yes, [PII] and the extension is [PII]. And may I know your name and spelling?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII] Thank you.
[AGENT][NEUTRAL] Right, and then, um, can I get that policy number, please?
[CUSTOMER][NEUTRAL] Yes, member ID.
[CUSTOMER][NEUTRAL] 02583369
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Yes. [PII], and date of birth [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. Alright, do you have that uh original claim number for the appeal?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, 356-685-2.
[CUSTOMER][NEUTRAL] And uh the appeal we have submitted on.
[CUSTOMER][NEUTRAL] [PII] [PII] through mailing and this is a follow up call. I recently spoke with [PII], the app is process.
[CUSTOMER][NEUTRAL] May I have the exact field status?
[AGENT][NEUTRAL] OK, I'm sorry, just so that I understand correct that original claim that was uh 356-685-2, is that right?
[CUSTOMER][NEUTRAL] Yes, claim number
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] So I let me take a look. I'm not showing that we've received anything from a provider.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Would you like data service and build amount?
[AGENT][NEUTRAL] That was, uh, wasn't, uh, [PII]?
[CUSTOMER][NEUTRAL] Yes, and the bill amount is $36 even 36.
[AGENT][NEUTRAL] Right. Yeah, I don't see.
[CUSTOMER][NEUTRAL] 3, the claim 356-852.
[AGENT][NEUTRAL] Yes, I, I was able to locate the original claim. however, I do not see anything about any appeal that has been received.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, give me a moment. The claim has been denied. The claim has been denied maximum benefit time period reached. We have recently spoke with [PII].
[CUSTOMER][NEUTRAL] Yeah, I spoke with [PII]
[AGENT][NEUTRAL] OK, yes, I do see that. However, I do see her stating that no appeal information uh has been uh was available at the time.
[CUSTOMER][NEUTRAL] Uh, which means
[AGENT][NEUTRAL] We have not yet received that appeal information so that might have to be resent to us.
[CUSTOMER][NEUTRAL] Uh, we need to resubmit the appeal again.
[AGENT][NEUTRAL] Um, I mean if you, uh, said that you submitted that in March, we have no record of it, so yes, I do believe that needs to be resubmitted.
[CUSTOMER][NEUTRAL] 151 and uh uh give me a minute. We have recently spoke with [PII]. Could you please verify the notes for previous caller notes, [PII].
[AGENT][NEUTRAL] I do see that.
[AGENT][NEUTRAL] Right, I am looking at those notes and I do see her saying that there is no appeal information at this time.
[CUSTOMER][NEUTRAL] Mhm. For this one, can the bill again. The mailing address is [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Correct. I've also got a fax number I can give you if you'd like.
[CUSTOMER][NEUTRAL] Uh, give me a minute. And we, the appeal got upheld maintaining original decision maintained. Could you please verify? We have received the correspondence. The appeal got upheld.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Could you repeat that? I'm sorry.
[CUSTOMER][NEUTRAL] We have received the correspondence. Could you please verify the appeal got upheld. We have the information. Could you please check one more time for me?
[AGENT][NEUTRAL] Do you have a claim number or an appeal number because I again I'm not seeing anything for that date of service.
[CUSTOMER][NEUTRAL] No, we have appeal appeal correspondence letter for the appeal reference letter.
[AGENT][NEUTRAL] OK then it's possible that it's still being processed however I don't see any appeal information.
[CUSTOMER][NEUTRAL] Uh, could you please send back for reprocess?
[AGENT][NEUTRAL] Say it again, I'm sorry.
[CUSTOMER][NEUTRAL] Yes, could you please send an escalate for this one?
[CUSTOMER][NEUTRAL] But the reprocess
[CUSTOMER][NEUTRAL] But there'll be
[AGENT][NEUTRAL] Yes, as soon as we're able to get that information we will be able to reprocess that.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Give me
[CUSTOMER][NEUTRAL] And we have the uh the appeal response that received on [PII].
[AGENT][NEUTRAL] OK, though there's no information in the letter though regarding a number or anything like that?
[CUSTOMER][NEUTRAL] Uh, we have a number, plane number 3566852 and uh we have a certificate number, would you like certificate number.
[AGENT][NEUTRAL] What was the number? I'm sorry? What kind of number?
[CUSTOMER][NEUTRAL] Yes, cert certificate number.
[AGENT][NEUTRAL] Oh, I believe that's just their policy number. Is that the 02583369?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yeah, so that's all the original informa.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] And the correspondence is in in response.
[CUSTOMER][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] As per services were quoted correctly, the responses stated and the medical reports for their services bill to APL to repossess your claim. Do you ever consider your claim and redetermine it was processed correctly.
[CUSTOMER][NEUTRAL] It's a responsibility to this.
[CUSTOMER][NEUTRAL] Are you sure there is no appeal on file, no recon is on file?
[CUSTOMER][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] Florida.
[CUSTOMER][NEUTRAL] [PII].