AccountId: 011433970860
ContactId: a8f14c31-5356-4dec-9904-27be01c83522
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 424500 ms
Total Talk Time (AGENT): 157005 ms
Total Talk Time (CUSTOMER): 114075 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/a8f14c31-5356-4dec-9904-27be01c83522_20250206T13:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII], and I'm calling for product office to check on additional information of the claim that has been denied. Please know this call is monitored and recorded for quality purposes. How are you doing today?
[AGENT][NEUTRAL] I'm good, [PII]. I'm sorry, what's the nature of your call again?
[CUSTOMER][POSITIVE] I'm good
[CUSTOMER][NEUTRAL] I'm calling about it. We have a claim status denied. I'm showing that payment is denied for time refund limit has been expired. I do require additional information about the claim.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What is your callback number, [PII] if we are disconnected?
[CUSTOMER][NEUTRAL] [PII] is a direct line?
[AGENT][NEUTRAL] What is the policy number, please, [PII]? Thank you.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] And what is the policy number for the member that you call in regards to?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] The member ID it will be?
[CUSTOMER][NEUTRAL] 01602947.
[AGENT][NEUTRAL] Thank you. OK, I have that as 01602947. Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, I have that number pulled up and you can you call for claim status, um, do you have a date of service I can check for you?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] The data of service, it is.
[CUSTOMER][NEUTRAL] The service is [PII] and the bill amount is $240 even.
[AGENT][NEUTRAL] OK, let me repeat that to you. I have that as [PII], total charges $240. Is that correct?
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] OK, thank you. Now in regards to this particular policy, this policy termed as of [PII], there is no claim on file. Bear with me, let me check for an active policy for the member, OK? And I get the information to you.
[AGENT][NEUTRAL] If you would also verify the procedure codes bill for the service date for the member please.
[CUSTOMER][NEUTRAL] like
[CUSTOMER][NEUTRAL] It's 99213971046.
[AGENT][NEUTRAL] OK, thank you so much. Now it shows that the claim was received under a different policy number. Let me provide that information to you, one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. The policy number shows 01752124.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was received on, give me one second, on [PII] and it was processed and denied on [PII].
[AGENT][NEUTRAL] It shows that this claim has denied. I'm sorry.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] What is the time limit for the insured claim?
[AGENT][NEGATIVE] There is no timely filing limit. However, this policy has termed, there is no active policy for the member.
[CUSTOMER][NEUTRAL] OK, what is the time limit for the Karak claim?
[AGENT][NEUTRAL] There is no timely filing limit to submit a claim.
[CUSTOMER][NEUTRAL] OK, no time limit.
[CUSTOMER][NEUTRAL] And what is the time limit for appeal?
[AGENT][NEUTRAL] 180 days from the claim decision.
[AGENT][NEUTRAL] Do you have the claim number? If not, I can provide that information to you.
[CUSTOMER][NEUTRAL] Yes, I have the same number.
[AGENT][NEUTRAL] OK, and what claim number do you have? Just to verify.
[CUSTOMER][NEUTRAL] The claim number is?
[CUSTOMER][NEUTRAL] 3552155. And what is the appeal mailing address? Just for my documentation purpose for the future reference.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] Of course, it is APL claims attention appeals department.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Well
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] Your [PII] [PII].
[CUSTOMER][NEUTRAL] [PII] right.
[AGENT][NEGATIVE] No, that is not correct. The [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Attention will be?
[AGENT][NEUTRAL] Appeals department.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And do you require any specific form for a bill?
[AGENT][NEUTRAL] I'm sorry, I didn't understand.
[CUSTOMER][NEUTRAL] Do you require any form or gen the cover letter for.
[AGENT][NEUTRAL] Just a couple letter, a cover letter would do.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] The policy is term, right?
[AGENT][NEUTRAL] I'm sorry. Say that again, please.
[CUSTOMER][NEUTRAL] The claim is denied as the policy is termed, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And what is the effected date?
[AGENT][NEUTRAL] The effective date shows [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] And term date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], that is correct.
[CUSTOMER][NEUTRAL] When will the C be updated?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] When was the coordination of benefits submitted?
[AGENT][NEUTRAL] We do not coordinate benefits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. May I have the contact number?
[AGENT][NEUTRAL] It would be my name [PII] last initial [PII], and today's date. Anything else I can assist you with, [PII]?
[CUSTOMER][NEUTRAL] It would be
[CUSTOMER][POSITIVE] Thank you for asking me. Have a good day. Bye-bye.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day bye.