AccountId: 011433970860
ContactId: 984b56c3-11e0-4b55-bc96-30b97c339ba1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 382540 ms
Total Talk Time (AGENT): 160988 ms
Total Talk Time (CUSTOMER): 116544 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/2025/05/12/984b56c3-11e0-4b55-bc96-30b97c339ba1_20250512T15:25_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling to get a um status of a claim.
[AGENT][NEUTRAL] OK, I can help you with the claim status. And may I have your name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And [PII], may I have a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] Yes, it's um [PII].
[CUSTOMER][NEUTRAL] Policy number is 02536629.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, um, [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] And the total amount was $103.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] $103.
[AGENT][NEUTRAL] Is there any other ones? No, OK. And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Um, Hattiesburg Clinic.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Oh, that's
[AGENT][NEUTRAL] Alright, so I'm showing that the claim was received on [PII].
[AGENT][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 351.
[AGENT][NEUTRAL] 492 4.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Um, as it wasn't a covered diagnostic or diagnostic test, um, the policy only covers MRIs, CT scans, and colonoscopies.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, we had a um.
[CUSTOMER][NEUTRAL] A corrected claim should have been sent in on [PII]. Do you see that one?
[AGENT][NEUTRAL] Yes, let me get that one. Hold on one second, I think that was this one.
[AGENT][NEUTRAL] Um, you said [PII]?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEGATIVE] Oh, well, we did receive a corrected claim, but it was November, we received it on [PII], but we haven't received anything after that.
[CUSTOMER][NEUTRAL] OK, yeah, I see what she sent in the um claim in November.
[CUSTOMER][NEUTRAL] But then,
[CUSTOMER][NEUTRAL] I guess they had to do it since corrected replacement claim.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] And the claim number was 3514924.
[AGENT][NEUTRAL] Well, now that's the original claim number.
[CUSTOMER][NEUTRAL] But that's all the same.
[CUSTOMER][NEUTRAL] Yeah, that's, it was I guess it was added something was added to that.
[AGENT][NEUTRAL] But March though, because we have a, let me see if there's another policy.
[AGENT][NEGATIVE] Because we haven't received anything from this one since November or not at all.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, no, as of right now, the member doesn't have like any active policies with us, but for the one that we were just looking at, we hadn't received anything after [PII].
[CUSTOMER][NEUTRAL] Right
[AGENT][NEGATIVE] But the one that she did send in November, that one was denied as a duplicate, but we haven't received anything after that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, yeah, I see the now I do it.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEGATIVE] Maybe she tried to send it and it didn't go through.
[AGENT][NEUTRAL] Yeah, I'm not sure.
[CUSTOMER][NEGATIVE] But the first, the first denial was for.
[CUSTOMER][NEUTRAL] When did it, when it denied the first time. What was what was the reason again?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, let me see. The original did not because it wasn't a covered diagnostic test.
[CUSTOMER][NEUTRAL] The original because it wasn't a.
[AGENT][NEUTRAL] Because this, this policy limits it only to MRI, CT scans, and colonoscopies.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So only MRI.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] CT
[AGENT][NEUTRAL] And colonoscopy.
[CUSTOMER][NEUTRAL] And colonoscopy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] OK, can I get a a reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initials of my last name is [PII], and my name is [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yeah, let me ask you this what was the um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like the time limit, time frame I could get like a correct the claim or a reconsideration if need be.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Um, there's no timely filing, there's no timely filing limit at all. Um, as long as the policy is active, you can file the claim at any time, but for a corrected claim or additional information, you can just send that in and then we'll process it once we get it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][NEUTRAL] Alright.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um, no, ma'am, that's all.
[AGENT][POSITIVE] Alright, well, thank you so much for calling APL [PII]. I hope you have a great week.
[CUSTOMER][POSITIVE] All right you too thank you.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye, bye bye.