AccountId: 011433970860
ContactId: bae4273b-5829-46e3-9787-3a30e9a00761
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 238380 ms
Total Talk Time (AGENT): 95827 ms
Total Talk Time (CUSTOMER): 62902 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/bae4273b-5829-46e3-9787-3a30e9a00761_20250121T14:23_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] Yeah, hi, [PII]. This is [PII] calling from Bar's office to check on claim status.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status. [PII], and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it is uh 01611664 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And you said this is for claim status?
[CUSTOMER][POSITIVE] Uh yes, that is correct.
[AGENT][NEUTRAL] And can you provide the data service for the claim?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII]. The amount is $230 even.
[AGENT][NEUTRAL] Thank you for that. And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I locate that claim for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yes, it is Hekcoarachin MDPA.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So I'm showing that the claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 783 2.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, and [PII], was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Just give me a moment.
[CUSTOMER][NEUTRAL] Yeah, uh, can you give me the reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date, which is [PII] to my last name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. And one more thing, uh,
[CUSTOMER][NEUTRAL] What's your uh appeals fax number if you have it?
[AGENT][NEUTRAL] 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK, so this is your appeal fax number, correct?
[AGENT][NEUTRAL] Yes, and that'll be attention APL appeal department.
[CUSTOMER][NEUTRAL] OK. And uh what about the mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK. What's the filing limit?
[AGENT][NEUTRAL] You have 180 days from the denial date to file an appeal.
[CUSTOMER][POSITIVE] Oh thank you very much, uh, that's it.
[AGENT][POSITIVE] You're very welcome, [PII], and thanks for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Yeah, bye-bye.
[AGENT][NEUTRAL] Bye bye.