AccountId: 011433970860
ContactId: 96637347-6ee0-4d02-99c2-5362a7650d8c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 288510 ms
Total Talk Time (AGENT): 113180 ms
Total Talk Time (CUSTOMER): 92808 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/96637347-6ee0-4d02-99c2-5362a7650d8c_20250401T14:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from office to check on a claim status.
[AGENT][NEUTRAL] OK, yeah, I can check on a claim for you. uh, [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] Sure, it is [PII]. That's a direct line.
[AGENT][NEUTRAL] OK, thank you. And then did you have that policy number?
[CUSTOMER][NEUTRAL] Yeah, policy number is 01.
[CUSTOMER][NEUTRAL] 678
[CUSTOMER][NEUTRAL] 802 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK and then uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] And my name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Alright, thank you for verifying that [PII] uh what was the date of service for this claim, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK and then did you have that bill amount?
[CUSTOMER][NEUTRAL] Yeah, just $1,809 even.
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] I'm sorry, [PII], what was the name of the provider's office this was with?
[CUSTOMER][NEUTRAL] Uh, sure, one second. provide office name is.
[CUSTOMER][NEUTRAL] Pediatrics Medical Group of Florida.
[AGENT][NEUTRAL] OK. Yes, thank you for verifying that. OK, so we did receive this claim, [PII]. We were unable to pay a benefit as the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, you're saying non-covered, uh, which means, uh, member does not have any, uh, is it not covered under the member's plan or by providers contract?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Under this, their, their policy under this uh the member's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Of it is not covered under a member's plan.
[CUSTOMER][NEUTRAL] One second, let me take a note on that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, thank you for that information. So may I know the member's plan name and the plan type?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, uh, so the plan, it is a secondary medical policy.
[AGENT][NEUTRAL] The plan name is Medlik, M E D L I N K.
[CUSTOMER][NEUTRAL] OK, thank you for that. Uh, is it, uh, may I know the plan type like HMO BPO?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's, it's a secondary medical. It is supplemental.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, for this, can we build the patient?
[AGENT][NEUTRAL] We don't say what is patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, thank you for that information. And may I know the appeal mailing address and the time limit?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, our mailing address is [PII].
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK, this is the appeal address, right?
[AGENT][NEUTRAL] Correct, timely filing limit for appeals is going to be within 180 days of the process date. You give me one moment, I'll get that for you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this claim was processed [PII].
[CUSTOMER][POSITIVE] OK. Thank you for that information. OK, so really thank you for your assistance. May I know the reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] Uh, no, that's all for today. I really thank you for your assistance, care, and have a wonderful day.
[AGENT][NEUTRAL] All right. Of course.
[AGENT][POSITIVE] Thanks for calling APL. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.