AccountId: 011433970860
ContactId: b63290e7-5803-4e8e-a478-385968a90fdb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 615700 ms
Total Talk Time (AGENT): 250650 ms
Total Talk Time (CUSTOMER): 188156 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/b63290e7-5803-4e8e-a478-385968a90fdb_20250509T21:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi [PII]. My name is [PII] calling fromor's office to check on a client dinner clarification.
[AGENT][NEUTRAL] OK, I can check on that claim for you. I'm sorry, what did you say your name was?
[CUSTOMER][POSITIVE] Thank you so much for that. My name is [PII].
[AGENT][NEUTRAL] OK, uh, do, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yep, sure, I have a member ID for you. It's 0.
[CUSTOMER][NEUTRAL] 9128366.
[AGENT][NEUTRAL] OK, um, would you mind repeating that for me one more time, [PII] I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, you know, fine.
[CUSTOMER][NEUTRAL] 091
[CUSTOMER][NEUTRAL] 28366.
[AGENT][NEUTRAL] OK, so, um, I did not get a result with that policy number that does not appear to be one of ours uh do you maybe have their social I can search for them that way or uh do you have the claim number by chance?
[CUSTOMER][NEUTRAL] OK, that's
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] One second. I, once again, I checking ID card.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I have my ID card, medical ID is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII]. And I apologize for that, please.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] That that policy number is not through us, Joy that is actually through 90 Degree benefits, um, so I, I can give you their information and transfer you to them if you'd like, uh, or again if you have their social, I can see if they have a policy with us.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] One second, uh.
[CUSTOMER][NEUTRAL] Wait, I can provide a patient name.
[AGENT][NEUTRAL] Oh, do you have the claim number?
[CUSTOMER][NEUTRAL] I have it uh uh.
[CUSTOMER][NEUTRAL] Uh, it takes 2 to 3 minutes. Uh, could you please wait me for a claim number?
[AGENT][NEUTRAL] Sure, yeah, you're fine.
[CUSTOMER][POSITIVE] Yeah, thank you so much. I'll make it fast please with me.
[AGENT][NEUTRAL] Of course, no, you're fine.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Check number.
[CUSTOMER][NEUTRAL] I have a claim number for you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 353.
[CUSTOMER][NEUTRAL] 961 2.
[AGENT][NEUTRAL] OK, that was 353-39 excuse me 3539612.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Yes, wonderful.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Yup, sure. It will be [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you so much for verifying that. Uh, so the policy number you gave me, there was actually supposed to be a, it's, uh, I'll just go ahead and give you the correct policy number whenever you're ready.
[CUSTOMER][POSITIVE] Thank you so much
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][POSITIVE] Yeah, I'm ready for now.
[AGENT][NEUTRAL] OK, that is 01.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 928366.
[CUSTOMER][NEUTRAL] That's only he provided you.
[AGENT][NEUTRAL] Uh, no, I heard 09. I didn't, there was the one wasn't before the 9.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Oh talking for sir good evening.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so it looks like we did pay a.
[CUSTOMER][POSITIVE] Thank you my service.
[AGENT][NEUTRAL] Yes, so it looks like we did pay a benefit of $100 for this claim. Give me just a moment and OK, so that met their maximum amount payable for this date of service. So this is a limited indemnity medical plan, uh, so the maximum per date of service is $100.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But we're not
[CUSTOMER][NEUTRAL] So but uh claims you can pay a maximum of $100 only, right?
[AGENT][NEUTRAL] Yes, so these are for an office visit, uh, the maximum amount payable is $100 per uh per day. So for this particular date of service, the maximum amount payable was $100.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK, may I know the next data service.
[AGENT][NEUTRAL] Uh, did you have that claim number by chance? or was it just the date of service?
[CUSTOMER][NEUTRAL] No, no, data service. You can find the claim number for me, please.
[AGENT][NEUTRAL] And this is the same member, correct?
[CUSTOMER][NEUTRAL] Same number only.
[AGENT][NEUTRAL] OK, go ahead with that date of service.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] [PII] $312.37.
[AGENT][NEUTRAL] OK, that was [PII]?
[CUSTOMER][NEUTRAL] I apologize. [PII].
[AGENT][NEUTRAL] Oh, OK, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Uh, the only claim I have for that date of service [PII] is the claim number that you just gave me.
[CUSTOMER][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] The same claim number?
[AGENT][NEUTRAL] Yes, that's the only claim I have on file for this state of service for this number.
[CUSTOMER][NEUTRAL] So it's basically limited indemnity plan, right?
[AGENT][NEUTRAL] It's a limited indemnity medical plan.
[CUSTOMER][NEUTRAL] What will be the remaining amount? It will be patient responsibility?
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] You do it's not based on SOD but based on provider right?
[AGENT][NEUTRAL] We don't say what is or is not patient responsibility that is up to the provider.
[CUSTOMER][NEUTRAL] OK. May I know the bill mailing address?
[AGENT][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] May I know the state?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And the city?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Which
[CUSTOMER][NEUTRAL] May I know the time filing limit for appeal and the correct claim?
[AGENT][NEUTRAL] For appeals that would be within 180 days of the process date. If you'll give me one moment I'll get that information for you.
[AGENT][NEUTRAL] So this claim was processed [PII].
[AGENT][NEUTRAL] And if you were to step file an appeal, uh, you would have to include a letter stating, of course, that it is for an appeal with the uh corrected claim information.
[CUSTOMER][POSITIVE] Thank you so much. I have one last data service. Could you please assist me?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] One moment, I'm closing this one.
[CUSTOMER][NEUTRAL] The next one will be [PII].
[AGENT][NEUTRAL] [PII] and then I bill them out please.
[CUSTOMER][NEUTRAL] $456.16.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, um, that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, we have not received a claim for that date of service for this member.
[CUSTOMER][NEUTRAL] Can I resubmit the claim now?
[AGENT][NEUTRAL] Yeah, there's no timely filing limit for claims.
[CUSTOMER][NEUTRAL] Could you please provide me the patient policy effective date?
[AGENT][NEUTRAL] Effective date was [PII], and it is currently active.
[CUSTOMER][NEUTRAL] May I know the client's mailing address?
[AGENT][NEUTRAL] The mailing address is the same as the uh for appeals that's the same address for claims.
[CUSTOMER][NEUTRAL] For [PII], right?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Pay ready
[AGENT][NEUTRAL] 60801.
[CUSTOMER][POSITIVE] Thank you so much. Could you uh, may I know call reference number?
[AGENT][NEUTRAL] That 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?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That's all for no car.
[AGENT][POSITIVE] Oh great, thanks for calling APL have a great rest of your day.
[CUSTOMER][POSITIVE] Hi thanks for calling
[CUSTOMER][NEUTRAL] Yeah, you too.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Right.