AccountId: 011433970860
ContactId: c5d1e8c9-b507-407d-907b-cb2fa3a80b9c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 342239 ms
Total Talk Time (AGENT): 128338 ms
Total Talk Time (CUSTOMER): 111442 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/c5d1e8c9-b507-407d-907b-cb2fa3a80b9c_20250210T14:17_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi. Hi, this is [PII] calling from provider's office to check on the uphill status. Could you please assist me?
[AGENT][NEUTRAL] OK, [PII], you're checking on appeal status. Is that correct?
[CUSTOMER][POSITIVE] That's right.
[AGENT][POSITIVE] Yes, ma'am, I can help you. And what is your callback number?
[CUSTOMER][NEUTRAL] Sure, my callback number is [PII] with an extension of [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] Sure, the member ID is D as in Delta 43,730,160.
[AGENT][NEUTRAL] OK, now thank you [PII], but that is not the policy number for the member for APL. That would be a 90 degree benefit number. Does the patient also have a policy with, with APL?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm not aware of that actually. Or shall I provide you with the member's name and date of birth?
[AGENT][NEUTRAL] I can't search by date of birth. What is the last name?
[CUSTOMER][NEUTRAL] Sure. The last name is [PII], which is [PII].
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] One moment please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] My ID is [PII]
[AGENT][NEUTRAL] What state does this member live in?
[CUSTOMER][NEUTRAL] Yes, uh, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, and any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is her date of birth?
[CUSTOMER][NEUTRAL] Sure, her date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount that you're calling in regards to?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Sure, the date of service is [PII], which is for the total bill amount of $314 even 314.00.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so the most recently received claim, I did not see that we've requested an appeal request for her, but the most recently received claim do you already have that claim number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, the claim number is 352-890. Is that right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 352-589-0.
[CUSTOMER][NEUTRAL] 58 OK.
[CUSTOMER][NEUTRAL] OK, so, but you haven't received any appeal, is that right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, so just to confirm, the fax number will be [PII]. Is that right?
[AGENT][NEUTRAL] Mm, no, ma'am, I do not know what that number is for.
[CUSTOMER][NEUTRAL] OK. So can you please provide me with the correct fax number?
[AGENT][NEUTRAL] OK, OK. So if it's an appeal, you must submit that in writing.
[AGENT][NEUTRAL] And MS be mailed to [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. Also, may I get the timely filing limit?
[AGENT][NEUTRAL] An appeal must be filed within 180 days from the date of the decision.
[CUSTOMER][NEUTRAL] May I know the decision date?
[AGENT][NEUTRAL] This was [PII].
[CUSTOMER][POSITIVE] OK, got you. Thank you so much. And also may I get the call reference number for today's conversation?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, ma'am, you would use my name along with today's date, [PII].
[CUSTOMER][POSITIVE] Got it thank you so much.
[AGENT][NEUTRAL] And also if you need a copy, oh, I'm sorry, yes ma'am, and also if you need a copy of those explanation of benefits, you may print that by going to our portal at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, got you. Thank you so much for your assistance and have a great rest of the day. Bye for now and happy Monday.
[AGENT][POSITIVE] Yeah, I hope you do and happy Monday to you as well and thank you again, [PII], for calling APL.
[CUSTOMER][NEUTRAL] have
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Uh-huh.