AccountId: 011433970860
ContactId: 93c5020c-8c84-4ca2-aa09-81c35e9d6bc9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 357820 ms
Total Talk Time (AGENT): 71456 ms
Total Talk Time (CUSTOMER): 116902 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/93c5020c-8c84-4ca2-aa09-81c35e9d6bc9_20250521T13:44_UTC.wav
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[CUSTOMER][NEUTRAL] There's the
[AGENT][NEUTRAL] For calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from the provider's office to check on the claim. Could you please assist and how do you spell out your name?
[AGENT][POSITIVE] I'm happy to check on a claim. My name is spelled [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] Yes, and the member's policy number it is going to be.
[CUSTOMER][NEUTRAL] 2662731.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 2662731
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, you got.
[AGENT][NEUTRAL] That doesn't bring up a member policy. Do you have their name or social?
[CUSTOMER][NEUTRAL] Yes, the member's name is, I do have social event. The social is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] What is the patient's first and last name?
[CUSTOMER][NEUTRAL] Patient first name it is [PII] Last name it is [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Regarding date service, [PII] charges of $314 even.
[CUSTOMER][NEUTRAL] For this claim, I'm looking for an appeal status submitted on [PII].
[CUSTOMER][NEUTRAL] And that app will be submitted through fax.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Just one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like the appeal was received on [PII] and the decision was upheld.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. May I know what is the uphill date?
[AGENT][NEUTRAL] The process date was on [PII].
[CUSTOMER][NEUTRAL] OK. May I know the reason?
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Uh, the decision was upheld. The max benefit payable was paid.
[CUSTOMER][NEUTRAL] OK, thank you for that. Is there any additional documents need to be submitted to get this process?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, thank you. And for this one, could you please let me know what is the document control number, which means the appeal case number?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] 359-677-79
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, thank you. For this, could you please send me the determination letter over fax?
[AGENT][NEUTRAL] Yes, what's the fax number?
[CUSTOMER][NEUTRAL] 518
[CUSTOMER][NEUTRAL] 3943838.
[AGENT][NEUTRAL] 101
[CUSTOMER][NEUTRAL] You can use my name as attention too.
[AGENT][NEUTRAL] Can you spell your first name?
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Yeah, for sure. It is spelled out as [PII]. Last name to my initial [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. That is on its way. Give it about 5 minutes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, thank you for that. And for this, could you please provide me the caller reference number, sir [PII].
[AGENT][NEUTRAL] Call reference is my name with my last initial and then today's date. My name is [PII], last initial [PII].
[CUSTOMER][NEUTRAL] 74
[CUSTOMER][POSITIVE] OK, that is [PII] and today's tea. Thank you for that and have a great rest of your day and bye for now to SSA.
[AGENT][NEUTRAL] You too. Bye-bye.